South Dakota’s Motor Vehicle Traffic Accident Reporting ...

South Dakota’s Motor Vehicle Traffic Accident Reporting

Instruction Manual

South Dakota Department of Public Safety Office of Accident Records

April 2022

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Table of Contents Introduction .............................................................................................................................................................. 3 General Instructions ................................................................................................................................................. 4 Front Page Instructions ............................................................................................................................................ 6

Location ............................................................................................................................................................... 6 Unit Person .......................................................................................................................................................... 8 Owner .................................................................................................................................................................. 9 Vehicle ................................................................................................................................................................. 9 Trailer(s) ............................................................................................................................................................ 12 Commercial Vehicle .......................................................................................................................................... 12 Work Zone Related?/Workers Present?/School Bus Related? ........................................................................... 14 Object(s) Damaged ............................................................................................................................................ 15 Sequence of Events ............................................................................................................................................ 16

Back Page Instructions ........................................................................................................................................... 20 Transported to:/EMS Trip #/Seating Position/Persons Injured .......................................................................... 20 Accident Diagram .............................................................................................................................................. 24 Accident Narrative ............................................................................................................................................. 26 Witness............................................................................................................................................................... 26 Officer ................................................................................................................................................................ 26

Front Page Overlay Instructions ............................................................................................................................ 28 Vehicle Configuration (1) .................................................................................................................................. 28 Trailer Type (2) .................................................................................................................................................. 29 Cargo Body Type (3) ......................................................................................................................................... 30 Initial Point of Impact (4) / Most Damaged Area (5) ......................................................................................... 31 Underride/Override (6) ...................................................................................................................................... 32 Alcohol Use (7) .................................................................................................................................................. 32 Alcohol Test Status (8) ...................................................................................................................................... 33 Drug Use (9) ...................................................................................................................................................... 33 Drug Test Status (10) ......................................................................................................................................... 34 Work Zone Type (11) ........................................................................................................................................ 35 Work Zone Location (12) .................................................................................................................................. 35 Travel Direction Before Accident (13) .............................................................................................................. 36 Driver Contributing Circumstances (14) ............................................................................................................ 36 Vehicle Contributing Circumstances (15) .......................................................................................................... 37 Vehicle Maneuver (16) ...................................................................................................................................... 38 Traffic Control Device Type (17) ...................................................................................................................... 39 Vision Contributing Circumstances (18) ........................................................................................................... 41 Road Contributing Circumstances (19) .............................................................................................................. 41

Back Page Overlay Instructions ............................................................................................................................. 43 Manner of Collision (With motor vehicle in transport) (A) ............................................................................... 43 Location of First Harmful Event (B) .................................................................................................................. 44 Roadway Surface Condition (C) ........................................................................................................................ 45 Relation to Junction (D) ..................................................................................................................................... 45 Light Condition (E) ............................................................................................................................................ 51 Weather Conditions (F) ...................................................................................................................................... 51 Non-Motorist Action (G) ................................................................................................................................... 52 Non-Motorist Contributing Circumstances (H) ................................................................................................. 52 Non-Motorist Location (I) ................................................................................................................................. 53 Roadway Alignment/Grade (J) .......................................................................................................................... 53 Roadway Surface Type (K)................................................................................................................................ 54 Trafficway Description (L) ................................................................................................................................ 54

Investigator’s Property Damage only Wild Animal Accident Form (Short Form) ................................................ 55 Example Reports .................................................................................................................................................... 57 Overlay .................................................................................................................................................................. 73 Appendix A ............................................................................................................................................................ 75 Appendix B ............................................................................................................................................................ 76 Appendix C ............................................................................................................................................................ 77 Appendix D ............................................................................................................................................................ 78

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Introduction The primary goal of the South Dakota Accident Reporting System is to produce computerized statistical data for use in identifying problems and developing countermeasures necessary to reduce motor vehicle traffic accidents in number and severity. YOU, as a law enforcement officer who investigates accidents, are a key factor in achieving this goal. The quality of the data in an accident reporting system can never be better than what is received from the field. It is the responsibility of the officer investigating an accident to provide both correct and comprehensive data to the Department of Public Safety - Office of Accident Records. An individual accident may appear at times to be insignificant, but when combined with like accidents at or near the same location, various patterns emerge to identify problems in need of engineering, law enforcement, or educational attention. This manual serves two purposes. First, it provides instructions for completion of the South Dakota Accident Report Form. Second, it provides more detailed explanations of much of the data that is requested by the report. The report entitled State of South Dakota Investigator’s Motor Vehicle Traffic Accident Report, Form DPS-AR-1, requires two types of entries. The first type is written entries placed in the body of the report. The second type is numbered entries placed in the boxes which are located on the left and right margins on both front and back of the form, the lower right-handed corner of the front page and the upper section of the back page. The entries to the boxes are made by placing the folded overlay, Form DPS-AR-2, over the report form, lining up the proper boxes with the proper arrows on the overlay. Note that numbers are used to identify the boxes on the front side and alphabetics are used on the back side of the form.

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General Instructions

In order to determine when an accident should be reported to the state, it is important to have a clear understanding of the definition of a MOTOR VEHICLE TRAFFIC ACCIDENT and to know in what circumstances such an accident is state reportable.

For purposes of the South Dakota Accident Reporting System, report those accidents which involve at least one motor vehicle within a trafficway (includes the entire area within the right of way) or outside the trafficway if control was lost within the trafficway and cause a fatality, injury, or property damage to an apparent extent of $1000.00 or more to any one person’s property or $2000.00 or more per accident. Note! For the “$2,000.00 or more per accident” threshold to be reached, 3 or more person’s property would need to be involved. For example, 3 vehicles are involved in an accident and sustain damage, but no personal injuries to occupants or non-motorists, in the following amounts: unit 1 - $400, unit 2 - $800, and unit 3 - $800 totaling $2,000. None of the units reached the $1000 threshold, which would have automatically made the accident state reportable but because of the “$2,000.00 or more per accident” threshold this 3 unit accident would be reportable to the Office of Accident Records.

The following examples of incidents which DO and DO NOT meet the criteria for a Motor Vehicle Traffic Accident will also help in clarifying the definition given above.

• A passenger car loses control on a curve and runs off the road where it sustains extensive bodydamage (over $1000.00) after it leaves the trafficway right of way and enters a shelterbelt. Nodamage to the vehicle or injury to the occupants was sustained while within the right of way.

This incident qualifies as a motor vehicle traffic accident even though no injury or damage tookplace within the right of way. The determining factor is that the unstabilized condition BEGANwithin the trafficway.

• A snowmobile traveling in the ditch of a state highway impacts a drainage culvert. The driversustains a broken arm.

This incident qualifies as a motor vehicle traffic accident because snowmobiles are consideredmotor vehicles, the incident took place within the trafficway right of way of a public highway,and injuries were sustained.

• A driver loses control of a vehicle while backing from a garage on private property. Thevehicle travels out of the driveway and impacts a car properly parked along the curb on theopposite side of the street. The vehicles sustain accumulated damage of $2000.00 as a result ofthe impact.

This incident qualifies as a motor vehicle traffic accident even though the unstabilized eventbegan on private property. The determining factor is that the damage causing event occurredwithin the trafficway right of way.

• A driver stops a vehicle at the side of the road to check an unusual noise in the enginecompartment. The engine is left running and the car is in parking gear. After the driver raises

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the hood, the transmission jumps out of park and the driver is killed when the vehicle runs over him.

This incident qualifies as a motor vehicle traffic accident even though the vehicle was driverless at the time of the incident. Note that the definition of a motor vehicle accident presented above does not require that a vehicle have a driver.

• A motorhome is traveling on the interstate when a hose from an attached propane tankdisconnects and begins to burn. The fire spreads to the motorhome. The motorhome is broughtto a stop and all persons escape without injury, but the motorhome is completely destroyed byfire. The motorhome was valued at $4000.00.

This incident qualifies as a motor vehicle traffic accident even though there was no collision orrollover.

• Two vehicles collide in a supermarket parking lot. Both vehicles sustain damage amounting tomore than $1000.00 and one driver sustains a gash from impacting the windshield.

This incident does NOT qualify as a motor vehicle traffic accident because the entireunstabilized event occurred outside of a trafficway. The injury and damage are irrelevant in thiscase.

Notes! Because determination of whether or not an incident qualifies as a state reportable motorvehicle accident is an extremely complex question, there will be situations where anunderstanding of the definition and examples above will not provide an answer. If there is anyquestion as to whether of not a particular incident qualifies as a motor vehicle traffic accident,an accident report should be filed and the Office of Accident Records will make the finaldetermination.

The South Dakota Accident Report Form consists of two pages (one sheet printed front andback and an overlay for each page).

The remainder of this manual is divided into four sections. Each section provides specific, stepby step instructions for the completion of the two sides of the report and their associated“overlays”.

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Front Page Instructions

This section details how to fill out the Investigation Officer’s Report for a motor vehicle accident. The circled numbers shown in the blanks of the sample accident report refer to the number of the paragraph step explaining how to fill out that blank.

Location The following information details the Location section of the Investigating Officers Report of the Motor Vehicle Accident form.

Please Type or Print Submission: Original Amended Sheet of

LOC

ATI

ON

Date of Accident (MM/DD/YY) Time of Accident (HHMM) County

City Accident Occurred in or Indicate Rural

Road, Street or Highway Accident Occurred At its Intersection With

_________ Miles & Tenths Feet

N S E W

Of MRM (Milepost) ____ ____ ____ • ____ ____ NOTE: Unless accident occurred within an intersection completely described above, use space below to give the location from a junction or intersecting street.

(1st) _________ Miles & Tenths Feet

N S E W

Junction

}(2nd) _________ Miles & Tenths Feet

Of

Intersecting Street

1. Submission: – Check the box that indicates if this report is the original or an amended version.

2. Sheet __ of __ – Indicate the number of sheets submitted for this report. One front and back = one sheetand would be shown as “Sheet 1 of 1”. Two front and backs would be shown as “Sheet 1 of 2” for firstfront and back “Sheet 2 of 2” for the second front and back.

3. Date of Accident – Enter the date on which the accident occurred. The accident date must be entered inMonth/Day/Year format. In cases where the exact date of the accident may be in question (e.g.accidents occurring near midnight, officer judgement should be used.

4. Time of Accident – Enter the time on which the accident occurred. The time of the accident must beentered in a 24-hour clock format (military time). Note that midnight = “0000”. One minute aftermidnight is entered as “0001”. In cases where the exact time of the accident may be in question, officerjudgment should be used. Enter “Unknown” if a reasonable estimate of the accident time cannot bemade. Note! 2400 is not a valid time.

5. County – Enter the name of the county in which the FIRST injury or damage causing event of theaccident occurred.

FOR ACCIDENTS OCCURRING NEAR COUNTY BOUNDARIES – Note that many county lines arecoincident with the centerline of roads. For accidents in which the first injury or damage causing eventoccurs on a road which marks a county line and other accidents in which the first injury or damagecausing event is near a boundary line of two counties, the accident should be allocated to the county inwhich the first injury or damage causing event actually occurred not necessarily the county in which thevehicle(s) came to rest. If the first injury or damage-causing event is exactly on the boundary line, theaccident should be allocated to the county FROM which the vehicle was traveling for single vehicleaccidents. If the first injury or damage causing event is exactly on a boundary line when two or more

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vehicles coming from different counties are involved, the accident should be allocated to the county FROM which the vehicle with more severely injured occupants is traveling or to the county FROM which the vehicle with more severe damage is traveling if there are no injuries. If there is equal damage or injury in both vehicles, the investigating officer’s best judgment should be used.

6. City Accident Occurred in or Indicate Rural – Enter the name of the city or town in which the FIRSTinjury or damage-causing event of the accident occurred for all accidents occurring within theboundaries of a city or town. Enter “RURAL” for accidents occurring outside the boundaries of a city ortown.

FOR ACCIDENTS OCCURRING NEAR CITY LIMITS – For accidents occurring near a boundary lineof a city or town, allocate the accident to the city or town if the first injury or damage causing eventoccurred within the city limits. Do not allocate the accident to the city or town if the first injury ordamage causing event occurred outside the city limits even if the final resting place of the vehicle(s) isinside the city limits. If the first injury or damage causing event occurs exactly on the boundary line, theaccident should be allocated to the city or town IF one or more accident involved vehicles was travelingFROM within the boundaries of the city or town.

7. Road, Street or Highway Accident Occurred – Enter the trafficway number or name of the road onwhich accident occurred.

8. At its Intersection With – If the accident occurred within the boundaries of an intersection, enter thetrafficway number or name of the road which intersected with the trafficway entered in the “Road,Street, or Highway Accident Occurred” blank. For accidents not occurring at intersections, this lineshould be left blank. See figure 1 for the boundaries of an intersection.

9. Location with Respect to Mileage Reference Marker (MRM) – MRMs in South Dakota are placed onall State Highways. When an accident occurs on such a trafficway, the location of the accident shouldbe referenced to the nearest MRM. Enter the distance between the accident location and the nearestMRM in feet if the distance is less than 0.1 miles and in tenths of a mile if the distance is 0.1 miles orgreater. Check the box indicating whether the distance entered is in feet or in miles and tenths. Checkthe box indicating the direction of North, South, East or West from the MRM to the accident location.Note that the direction given should be the general direction of the trafficway. Enter the number of theMRM. This number could be a whole number or a whole number with hundredths. Always record theMRM exactly as it appears on the MRM post.

10. Location with Respect to a Junction or Intersecting Street – Accidents which occur on trafficwaysnot marked with MRMs (county roads, city street, etc) must be located with respect to a junction orintersecting street. Space is allocated for entering up to two distances and directions from the referencepoint.

Example: An accident was located 1 mile West and one half mile North of the junction of US12 andSD37. The following would be entered: On the first line, 1.0 would be entered in the blank and the “W”box would be checked; on the second line, 0.5 would be entered in the blank and the “N” box would bechecked; the “Junction” box would be checked; then the junction “US12 and SD37” would be entered inthe space provided.

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Unit Person This section of the Investigating Officers Accident Report details information concerning the person driving the vehicle at the time of the accident or the non-motorist identified in the unit section.

Full Name (Last, First, Middle)

Address

City State Zip

Date of Birth

Phone No

Driver’s License Number

Citation Charge? Yes No Pending Unknown

DL State

DL Class

DL Status:

Normal, within restrictions No license required

Violation:

Beyond restrictions Under suspension

Revoked No license Expired license No license endorsement for this vehicle type

Unknown

1. Full Name (Last, First, Middle) – Enter the name of the operator/driver of the unit or the

pedestrian identified as this unit. Names are to be entered for all unit types. If the unit is a motor vehicle without a driver, enter “None”. Enter the operator/driver’s full name in last, first, middle format. If the operator/driver is operating a motor vehicle and is licensed, the name MUST be entered EXACTLY as if appears on the driver’s license. It is extremely important that the name be entered on the accident report exactly as it appears on the license because a record of the accident is transferred to the driving record of South Dakota drivers as required by SDCL 32-12-61.

2. Address – If there is a name in the unit full name field, enter the current address of that person.

If there is no name in the full name field, enter “None”. (See Appendix A for state codes)

3. Date of Birth – Enter the date of birth of the person in the unit full name field. Date of birth should be entered in the Month/Day/Year format.

4. Phone Number – Enter the phone number of the person in the unit full name field.

5. Driver’s License Number – For drivers of motor vehicles, enter the driver’s license number.

If the person does not have a driver’s license, enter “None”. Do not enter an Identification Card number as a driver’s license number.

6. Citation Charge – List any violations with which the person in the unit full name field was

charged. There is space for violations to be listed on the front side of the report, please list additional violations in the narrative area of the report. Note that in cases where charges are pending, the report may be held up to five (5) working days to allow for determination of actual charges filed. Also check the appropriate box to the right of “Citation Charge?” ( Yes No Pending Unknown).

7. DL State – For drivers of motor vehicles, enter the state issuing the driver’s license. For

unlicensed drivers, enter “None”. (See Appendix A for state codes)

8. DL Class – For drivers of motor vehicles, enter the class as it appears on the driver’s license. For unlicensed drivers or out of state drivers without a class, enter “0 (zero)”.

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9. DL Status – For drivers of motor vehicles, check the appropriate box to indicate the current status of an individual’s driver license.

Owner This section of the Investigating Officers Accident Report details information concerning the owner of the vehicle at the time of the accident identified in the unit section.

Owner’s Name (Last, First, Middle) Check if Same as Driver

Address

City State Zip

1. Owner’s Name – Enter the full name of the owner. If the owner of the unit is the same as the

operator/driver of the unit, check the “Check if Same as Driver” box. The operator/driver name does not need to be re-entered. For railway vehicles, enter the name of the Railroad Company.

2. Owner’s Address – Enter the current address of the owner. If the owner is the same as the

operator/driver, this field may be left blank. (See Appendix A for state codes)

Vehicle This section of the Investigating Officers Accident Report details information concerning the vehicle identified in the unit section.

VIN #

Insurance Co Name

Insurance Policy #

Eff Date

Exp Date

Model Yr

Make

Model

License Plate #

State Year Damage Amount Veh and Contents $

Total Occupants

Speed Limit

Est Travel Speed _________

Speed – How Estimated:

Officer Estimate Driver Statement

Occupant Statement Witness Statement

No Estimate

Hit and Run? Yes No Unknown

Damage Extent: None - No Damage Minor Damage

Functional Damage Disabling Damage

Unknown Vehicle Towed? Yes No Unknown

Emergency Vehicle Use? Yes No Unknown

1. VIN # – Enter the vehicle identification number of the motor vehicle. This number should

NOT be taken from the vehicle’s registration slip. The VIN should be read from the actual vehicle identification plate. It is extremely important that the VIN be entered correctly in order to allow for accident research to identify vehicle problems.

2. Insurance Co Name – Enter the Insurance Company Name as it appears on the proof of

insurance card.

3. Insurance Policy # – Enter the Insurance policy number as it appears on the proof of insurance card.

4. Eff Date – Enter the date the insurance was effective. Effective date should be entered in

Month/Day/Year or Month/Year format.

5. Exp Date – Enter the date the insurance will expire. Expiration date should be entered in Month/Day/Year or Month/Year format.

6. Model Yr – Enter the model year of the motor vehicle involved in the accident. Note that the

model year may not be the same as the year of manufacture. It is the MODEL year that should be entered in this blank.

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7. Make – Enter the make of the motor vehicle involved in the accident. Note that many manufacturers produce several makes of vehicles. For example, General Motors produces Chevrolet, Buick, Oldsmobile, etc. It is the vehicle MAKE (Chevrolet, Buick, Oldsmobile, etc.), NOT the manufacturer, that should be entered in this field.

8. Model – Enter the model of the motor vehicle involved in the accident. The field should NOT

be used to enter vehicle body style or type, but rather, the class or family of vehicles within a make. For example, models of the Chevrolet make would include Corvette, Impala, Malibu, etc. Models of Ford pickups would include F150, F250, F350, etc.

9. License Plate # – Enter the vehicle license plate (registration plate) number and state and year

of license. The license plate number should be entered even if the plate has expired. If the motor vehicle does not have a license plate, enter “None”. (See Appendix A for state codes)

10. Damage Amount Veh and Contents – Enter the total dollar value of damage to the motor

vehicle, pedalcycle, railway vehicle, animal with rider (damage of animal only), animal drawn vehicle (animal and drawn vehicle) and its contents. Contents include anything carried in a passenger compartment other than persons. Also included are any property in the trunk or cargo area of a passenger vehicle and the load of any truck including the load in a semi-trailer. Estimates should be based on cost to repair with new parts.

11. Total Occupants – Enter the number of injured and uninjured occupants for this unit.

Occupants should include the operator/driver and all passengers of the unit.

12. Speed Limit – Enter the legal speed limit for the section of the trafficway on which the motor vehicle was traveling, whether or not the limit is posted. DO NOT enter cautionary speed limits such as posted on curve signs.

13. Est Travel Speed – Enter the estimated speed, as can be best determined, of the motor vehicle

as it was traveling on the trafficway BEFORE the accident. Enter “Unknown” if no estimate of speed can be made. (NOTE: If “Est Travel Speed “ is unknown, the “No Estimate” box should be checked for “Speed – How Estimate”)

14. Speed – How Estimated – Indicate how the estimate of travel speed was made by checking the

appropriate box. Use of the boxes should be governed by the following explanations: Officer Estimate – This box should be checked when travel speed was estimated by skid tests, skid marks and measurements, or by the officer’s expert judgment based on experience (extent of vehicle damage, etc.) Driver Statement – This box should be checked when the estimated travel speed was provided by the vehicle driver. Occupant Statement – This box should be checked when the estimated travel speed was provided by a vehicle occupant other than the vehicle driver. Witness Statement – This box should be checked when the estimated travel speed was provided by a non-occupant (by-stander) who witnessed the accident.

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No Estimate - This box should be used ONLY when the estimated travel speed is “Unknown”. (NOTE: If this box is checked, “Unknown” should be entered for “Est Travel Speed”).

15. Hit and Run? – Check the box which indicates whether the motor vehicle driver committed a “Hit and

Run” offense. Note that this item is coded for each motor vehicle with a driver, not for the accident as a whole. Do not complete if unit is not a motor vehicle with driver.

16. Damage Extent – Check the box describing the total damage to the motor vehicle from the accident.

None – No Damage – This box should be checked for an accident involved motor vehicle which does not receive property damage. Minor Damage – This box should be checked for an accident involved motor vehicle with damage that does not affect the operation of or disable the motor vehicle in transport. Included: Scratches, dented or bent fenders, bumpers, grills, body panels. Destroyed hubcaps. Functional Damage – This box should be checked for an accident involved motor vehicle with damage that is not disabling, but affects operation of the motor vehicle or its parts. Included: Doors, windows, hoods, trunk lids which will not operate properly. Broken glass which obscures vision. Tire damage even though the tire(s) may be changed at the scene. Bumpers which are loose. Any damage that would prevent the motor vehicle from complying with motor vehicle safety codes. Excluded: Dented or bent fenders, bumpers, grills, body panels. Destroyed hubcaps. Disabling Damage – This box should be checked for an accident involved motor vehicle with damage that prevents the departure of the motor vehicle from the scene of the accident in its usual operating manner by daylight after simple repairs. Included: Motor vehicles, which could be driven but would be further damaged by driving (Example – Motor vehicle with a leaking radiator.) Excluded: Damage, which can be fixed temporarily at the scene without special tools or parts. Tire disablement without other damage even if no spare is available. Headlight or taillight damage which would make night driving hazardous but would not affect daylight driving. Damage to turn signals, horn or windshield wipers, which makes them inoperative. Unknown – This box should be checked ONLY when the accident involved motor vehicle is not at the scene and is not available for inspection elsewhere.

17. Vehicle Towed? – Indicate whether the motor vehicle had to be towed from the scene as a result of

disabling damage. DO NOT count a vehicle that is towed, just because there is not a driver available to drive it away or situations involving just a flat tire.

18. Emergency Vehicle Use? – Emergency refers to an official vehicle that is traveling with physical

emergency signals in use, typically red light blinking, siren sounding, etc. Code yes only if the vehicle was on an emergency response at the time it was involved in the crash.

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Trailer(s) This section of the Investigating Officers Accident Report details information concerning the trailer(s) identified in the unit section.

Trailer License Plate # Attached to Power Unit: _______________________

State Year Trailer License Plate # Attached to Trailer Unit: ________________________

State Year

1. Trailer License Plate # Attached to Power Unit – For registered trailers attached to the powerunit, enter the trailer license plate (registration plate) number, registration plate year andregistration state. The license plate number, year and state should be entered even if the platehas expired. If the motor vehicle is not towing a trailer place an X in the blank. If the motorvehicle is towing a trailer that does not have a license plate, enter “None”. (See Appendix A forstate codes)

2. Trailer License Plate # Attached to Trailer Unit – For registered trailers attached to the firsttrailer, enter the trailer license plate (registration plate) number, registration plate year andregistration state. The license plate number, year and state should be entered even if the platehas expired. If the motor vehicle is not towing a second trailer place an X in the blank. If thistrailer does not have a license plate, enter “None”. If there are more than two trailers, providethis information in the narrative or on an additional page. (See Appendix A for state codes)

Commercial Vehicle This section of the Investigating Officers Accident Report details information concerning commercial motor vehicle identified in the unit section. This section must be completed:

IF the vehicle meets one or more of the following: • The vehicle has a Gross Combined Weight Rating (GCWR) of 10,001 or more pounds.• The vehicle displays a hazardous material placard.• The vehicle is designed to transport 9 or more people, including driver.

AND, the accident resulted in one or more of the following: • A fatality occurred.• An injury requiring transportation for immediate medical attention.• Any vehicle was disabled requiring a towaway from the scene. Note – please review

instructions for data field “Vehicle Towed?”

If this vehicle does not meet the requirement above, these fields should be left blank.

You must Complete Boxed area

IF the accident involved one or more of the following: • a truck having a GCWR of 10,001 or more pounds; OR• a vehicle displaying a hazardous material placard; OR• a vehicle designed to transport 9 or more people, including driver

AND, the accident resulted in one or more of the following: • a fatality; OR• an injury requiring transportation for immediate medical attention; OR• a vehicle was disabled requiring a towaway from the scene

Accident involved vehicle - Purpose? Commercial Interstate Commercial Intrastate Government Personal Carrier Name

Address City State Zip

US DOT # GVWR GCWR Placard # or Name Hazardous Material Released? Yes No Unknown

1. Accident involved vehicle – Purpose? – Check the box that identifies the purpose or use ofthis vehicle.

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2. Carrier Name – Enter the Carrier Name - the name of an individual, partnership or corporation responsible for the transportation of persons or property as indicated on the shipping manifest.

The identification of the Carrier can be found in three different ways? • The Carrier’s name may be displayed on both sides of the vehicle, usually the Driver’s side

door of the cab. • The Carrier’s name should be on the shipping papers carried by the Driver. In the case of a

bus, the driver carries a trip manifest or a charter order, which gives the name of the Motor Carrier.

• Ask the Driver for the Carrier’s name. 3. Address, City, State and Zip – Enter the Carrier’s current business address. (See Appendix A

for state codes)

4. US DOT # – Enter the US DOT # in this field. The US DOT # should be displayed on the power unit of the commercial vehicle and are usually found on the doors. The number for the United States Department of Transportation will be numeric and proceeded by “USDOT”.

5. GVWR – Enter the Gross Vehicle Weight Rating (GVWR) of the power unit. This is the value

specified by the manufacturer as the carrying capacity (loaded weight) of the vehicle.

Note: The GVWR label of the power unit can usually be found on the driver’s door, door-post, or door edge. The GVWR on a bus is located in the passenger compartment next to the driver’s seat.

6. GCWR – Enter the Gross Combined Weight Rating (GCWR) of this vehicle. The GCWR is

the sum of all GVWRs for each unit in a combination unit motor vehicle (including the truck tractor). Thus for single-unit trucks there is no difference between the GVWR and the GCWR. For combination trucks (truck tractors pulling a single semi-trailer, truck tractors pulling double or triple trailers, trucks pulling trailers, and trucks pulling other vehicles) the GCWR is the total of the GVWRs of all units in the combination.

Note: The GVWR label on a trailer is usually located on the front of the trailer near the vehicle’s serial and model number, or on the tongue.

7. Placard # or Name – If the vehicle has a hazardous materials placard, record the 4-digit

placard number or name taken from the middle of the diamond and the 1-digit placard number from bottom of the diamond.

8. Hazardous Material Released – Check the box that indicates whether or not hazardous

material was released from the cargo compartment. Hazardous material release should be documented whether or not the motor vehicle displayed a placard.

Note: Fuel spilled from the vehicle fuel tank should NOT be recorded as a hazardous material release, even though it is hazardous material.

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Work Zone Related?/Workers Present?/School Bus Related? This section of the Investigating Officers Accident Report details information concerning work zones and school bus involvement in an accident.

Work Zone Related? Yes No Unknown

Workers Present? NA Yes No Unknown

School Bus Related?

No Indirectly Involved Directly Involved Unknown

Work Zone Data Collection Comments – The accurate recording of accidents which occur in work zones is very important in the development of countermeasures to reduce accidents and severity for both the traveling public and workers. Due to the detail of work zone data collection it is strongly recommended to review the instructions whenever reporting accidents which occur in and around work zone areas. Work zone data collection involves four (4) data fields: Work Zone Related? Workers Present? Work Zone Type (code box 11) and Work Zone Location (code box 12). The first data field, “Work Zone Related?” is a question. If the answer to question is NO then the other 3 data fields are to be recorded as 96 – Not applicable. The first data field, “Work Zone Related?” is somewhat misleading because of the word related. The word related refers to collecting those accidents before the first warning sign or after the last exit sign if the accident resulted from an activity, behavior or control related to the movement of the traffic units through the work zone. ALL work zone accidents, which occur between the first warning sign and the final termination area sign, are to be recorded as work zone accidents. It is recommended to view the Diagram of a Work Zone Area – Appendix B. 1. Work Zone Related? – Indicate whether an accident occurred in or related to a construction,

maintenance, or utility work zone, whether or not workers were actually present at the time of the accident. See Appendix B for work zone diagram. Note: Was the accident in or near a construction, maintenance or utility work zone? If the answer to one of the 2 statements below is yes, select yes. If No is marked, the other work zone questions should be coded 96 for “Not applicable”. • Did the first harmful event occur within the boundaries of a work zone? • Did the first harmful event occur on an approach to or exit from a work zone, resulting

from an activity, behavior, or control related to the movement of the traffic units through the work zone?

2. Workers Present? – Indicate whether workers were present in the work zone.

3. School Bus Related – Indicate if a school bus or vehicle functioning as a school bus for a

school-related purpose is directly as a contact vehicle, or indirectly as a non-contact vehicle, related to the accident.

Note: The school bus or vehicle functioning as a school bus may be owned by the school

district or hired from a private company to transport children for school related purposes. The school bus or vehicle functioning as a school bus, with or without a passenger on board, must be directly involved as a contact vehicle or indirectly involved as a non-contact vehicle. Examples of indirect involvement are: a child, as a pedestrian, is struck

1 2 3

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by a passing motor vehicle either as the child is approaching or leaving a school bus stopped with its red lights flashing; two vehicles colliding as the result of the stopped school bus, etc. Caution – Only a school bus or vehicle functioning as a school bus directly involved as a contact vehicle can be listed as a unit on the accident report. Refer to indirect involved vehicles in the narrative and draw them on the diagram only.

Object(s) Damaged This section of the Investigating Officers Accident Report details information concerning object(s) damaged other than vehicles as a result of the accident.

Object(s) Damaged (Property other than vehicles and contents)

Owner’s Name (Last, First, Middle) Estimate of Damage $


1. Object(s) Damaged (Property other than vehicles and contents) – List all objects of valuedamaged as a result of the accident, EXCEPT motor vehicles, motor vehicle contents (includingload), persons and persons clothing. If no objects were damaged, enter “None”.

Note: Example of included objects – sign posts, guard rails, fences, buildings, domesticanimals with value such as cattle. Example of excluded objects – motor vehicles either on or off the trafficway, wild animals, rocks and boulders, snow banks, embankments.

2. Owner’s Name (Last, First, Middle) – Enter the name of the owner(s) of the damagedobject(s) listed previously. For objects such as sign posts and guard rails enter “State of SouthDakota” or the appropriate county or local governmental agency.

3. Estimate of Damage – Enter the total dollars amount of damage to the objects listedpreviously. Make the best estimate of dollar amount damage using the information you haveavailable to you. In cases involving damage to animals of value, use the owner’s estimate ofvalue.

4. Address, City, State and Zip – Enter the address of the owner(s) of the damaged object(s)listed previously. (See Appendix A for state codes)

1

2 3

4

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Sequence of Events This section of the Investigating Officer’s Accident Report details information concerning the sequence of events, most harmful and first harmful events of the accident.



School Bus Related?


Unit 1 Unit 2 Sequence of Events

___ ___ ___ ___ First Event Object(s) Damaged (Property other than Vehicles)

___ ___ ___ ___ Second Event Owner’s Name (Last, First, Middle) Estimate of

Damage $ ___ ___ ___ ___ Third Event

___ ___ ___ ___ Fourth Event Address City State Zip

___ ___ ___ ___ Most Harmful Event by Vehicle (use codes 7-66 only)

___ ___ First Harmful Event of Accident (use codes 7-66 only)

SEQUENCE OF EVENTS/MOST HARMFUL EVENT/FIRST HARMFUL EVENT (Front page of form, lower right) Collision of a Motor Vehicle in Transport with fixed object:

40 Impact attenuator/crash cushion 55 Curb Non-collision: Collision of a Motor Vehicle in Transport with: 41 Bridge overhead structure 56 Ditch

1 Equipment failure (tires, brakes, etc) 20 Pedestrian 42 Bridge pier or support 57 Embankment 2 Separation of units 21 Pedalcycle 43 Bridge rail 58 Approach 3 Ran off road right 22 Railway vehicle 44 Guardrail face 59 Construction - pavement 4 Ran off road left 23 Animal - wild 45 Guardrail end cutout/road materials 5 Cross median/centerline 24 Animal - domestic 46 Concrete traffic barrier 60 Fence 6 Downhill runaway 25 Motor vehicle in transport 47 Other traffic barrier 61 Mailbox 7 Overturn/rollover 26 Parked motor vehicle 48 Highway traffic sign post/sign 62 Tree/shrubbery 8 Fire/explosion 27 Motor vehicle used as equipment (Snowplow 49 Traffic signal support/signal 63 Delineator post 9 Immersion plowing, etc) 50 Overhead sign support/sign 64 Rock

10 Jackknife 28 Work zone/maintenance equipment 51 Light/luminaire support 65 Snow bank 11 Cargo/equipment loss or shift 29 Barricade 52 Utility pole 66 Other* fixed object 12 Fell/jumped from motor vehicle 30 Other* movable object 53 Other post, pole or support (wall, building, tunnel, etc) 13 Other* non-collision 54 Culvert

1. Sequence of Events – Code the events in sequence by vehicle from beginning to end of theaccident. If more than four events occurred for a particular vehicle add subsequence events inthe narrative. All codes listed above are valid for sequence of events.

2. Most Harmful Event by Vehicle – Code the event that produced the most severe injury to anoccupant of this vehicle or, if no injury, the greatest property damage to this vehicle. ONLYuse codes 7-66. Note – Codes 1 through 6 are not, in themselves, harmful events.

3. First Harmful Event of Accident – The First Harmful Event is assigned for the accident andclassifies the event. Code the first injury or damage producing event that characterizes theaccident. ONLY use codes 7-66. Note – Codes 1 through 6 are not, in themselves, harmfulevents.

Example of assigning the 3 events:

A vehicle is out of control coming down a hill, the vehicle leaves the roadway on the right side, collides with a delineator post, overturns in the ditch, ejecting and pinning the driver under the vehicle.

Sequence of Events: 1-Downhill runaway: 2-Ran off road right: 3-Collision with Delineator post: 4-Overturn/rollover

1

2

3

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First Harmful Event: Collision with Delineator (the first injury OR damage producing event)

Most Harmful Event: Overturn/rollover

Codes (Sequence of Events/Most & First Harmful Events):Non-collision 1 Equipment failure (tires, brakes, etc.) 2 Separation of units 3 Ran off road right 4 Ran off road left 5 Cross median/centerline 6 Downhill runaway 7 Overturn/rollover – A motor vehicle that has overturned at least 90 degrees to its

side. 8 Fire/explosion 9 Immersion/Partial Immersion – an in-transport motor vehicle enters a body of water and results in

injury or damage10 Jackknife – An uncontrolled articulation between a tractor and trailer(s) that occurs

at any time during the accident sequence. 11 Cargo/equipment loss or shift – The loss or release of the goods being transported

from the cargo compartment of the truck, or the change in the position of the goods within the cargo compartment. 12 Fell/Jumped from motor vehicle - is used when falling or jumping (not suicide) from the vehicle. For example a passenger of a motor vehicle in transport leans against the car door, it opens and the passenger falls out and is injured by the fall.13 Other non-collision – Includes such things as being injured within a vehicle whenno collision occurs. For example, an unbelted passenger hits his or her head on the roof of a vehicle and is injured, when the vehicle travels over a sharp dip in the road. Also includes situations where a passenger is sickened or dies due to carbon monoxide fumes leaking from a motor vehicle in transport. Include in non-collision accidents are damage or injury caused when an object is thrown or falls on a vehicle.

Collision of a motor vehicle in transport with a person, vehicle, or object not fixed

20 Pedestrian – A person who is not an occupant of a motor vehicle in transport. Includes a person who is adjacent to the motor vehicle regardless of their actions. Includes, wheelchair occupant, person on skates, skateboarders, etc.

21 Pedalcycle – Nonmotorized vehicle propelled by pedaling. Includes bicycle, tricycle, unicycle, pedal car, etc.

22 Railway vehicle – Any land vehicle (train, engine) that is (1) designed primarily for moving persons or property from one place to another on rails and (2) not in use on a land way other than a railway. Includes railway inspection vehicles while traveling on rails.

23 Animal - wild – Includes Deer, Antelope, etc. 24 Animal – domestic – Includes Cow, Horse, Hog, etc. Note - do not use this code for

domestic animals that are being used as transportation or to draw a wagon, cart or other transport device.

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25 Motor vehicle in transport – Any motorized (mechanically or electrically powered) motor vehicle not operated on rails. The term “in transport” denotes the state or condition of a transport vehicle that is in motion or within the portion of a transport way ordinarily used by similar transport vehicles. When applied to motor vehicles, “in transport” means in motion or on a roadway. Inclusions: motor vehicle in traffic on a highway, driverless motor vehicle in motion, motionless motor vehicle abandoned on a roadway, disabled motor vehicle on a roadway, etc.

26 Parked motor vehicle – A parked motor vehicle is a motor vehicle that is not in motion or on a roadway (the normal driving portion of the trafficway). To be considered parked, the motor vehicle must have been outside the area designated as the roadway and not moving. If any portion of the motor vehicle outline (excluding open doors, mirrors, etc.) is on a roadway it is not parked.

27 Motor vehicle used as equipment (snowplow plowing) – Use this code when there is a collision between a motor vehicle in transport and a motor vehicle used as equipment. Following is an example of a “motor vehicle used as equipment” – The most common is a snowplow plowing snow or sanding the highways. Others are gravel trucks while dumping their load, pavement packers while packing, etc. Note – When these motor vehicles are not being used as equipment and are being usedonly as transport vehicles moving persons and property from one place to anotherthey are “motor vehicles in transport” and should be coded 25.

28 Work zone/maintenance equipment – Equipment related to the work zone or roadway maintenance. Some examples are cranes, earthmovers, packers, etc., stationary, off the roadway. Note – this would not include motor vehicles in transport or motor vehicles used as equipment stopped on a roadway or in movement within the trafficway.

29 Barricade – A structure set up across a roadway to obstruct passage. 30 Other movable object – Includes fallen tree, already lying in roadway; objects on

the roadway which had fallen from a passing vehicle and had come to rest before being hit. Animals used as transportation, ridden animals and animals (or teams or animals) drawing a transport device (e.g., a horse drawing a sleigh, a team of horses drawing a stage coach, etc.).

Collision of a motor vehicle in transport with fixed object 40 Impact attenuator/crash cushion – A device at a spot location, designed to prevent

an errant motor vehicle from impacting a fixed object hazard by gradually decelerating the motor vehicle to a safe stop or by redirecting the motor vehicle away from the hazard. Examples include barrels filled with water or sand, and plastic collapsible structures.

41 Bridge overhead structure – Any part of a bridge that is over the reference or subject roadway. In accident reporting, this typically refers to the beams or other structural elements supporting a bridge deck.

42 Bridge pier or support – Support for a bridge structure other than at the ends. 43 Bridge rail – A barrier attached to a bridge deck or a bridge parapet to restrain

motor vehicles, pedestrians or other users. 44 Guardrail face – Other than the end of the guardrail. 45 Guardrail end – The end of the guardrail. 46 Concrete traffic barrier – A type of permanent median made of concrete that is

usually fixed but sometimes can be moved by special equipment to shift lane

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direction. This includes all temporary concrete barriers regardless of location (i.e., temporary Jersey Barrier on a bridge being used to control traffic during bridge repair/construction).

47 Other traffic barrier – Moveable barriers including cones, chains, law enforcement vehicle, etc.

48 Highway traffic sign post/sign – A sign intended to guide, regulate, or inform highway users. A pole, post, or structure constructed to support a highway sign intended to guide, regulate, or inform highway users.

49 Traffic signal support/signal – A signal intended to control traffic movements by illuminating systematically, a green, yellow, or red light or by flashing a single color light. A pole, post or other type of support for a traffic signal.

50 Overhead sign support/sign – A sign above the highway intended to guide, regulate or inform highway users. A pole, post, or structure constructed to support a highway sign intended to guide, regulate, or inform highway users.

51 Light/luminaire support – Light unit and supports for highway lighting systems. 52 Utility pole – Constructed for the primary function of supporting an electric line,

telephone line or other electrical-electronic transmission line or cable. 53 Other post, pole, or support – Used for posts other that highway signs. 54 Culvert – An enclosed structure providing free passage of water under a roadway

with a clear opening of less than twenty feet (6m) measured along the center of the roadway.

55 Curb – A raised edge or border to a roadway. Curbs may be constructed of concrete, asphalt, or wood and typically have a face height of less than 9 inches (225 mm).

56 Ditch – Developed primarily to collect and move water. It is adjacent to a highway and is usually identified as the roadside.

57 Embankment - A mound of earth or stone built to hold back water or to support a roadway.

58 Approach – Usually constructed of earth and developed primarily to provide access to another roadway including field approaches.

59 Construction – pavement cutout/road materials 60 Fence 61 Mailbox 62 Tree/Shrubbery – Tree/shrub is upright and in the ground. A standing tree is a

fixed object as opposed to a fallen tree, which is a moveable object. 63 Delineator post – A reflective device mounted at regular intervals along the side of

the road to indicate the horizontal alignment of the roadway. Delineators are oriented to face the driver for each approach. They are not used at intersections that generally have lighting and/or well-marked lane indications.

64 Rock 65 Snow bank 66 Other fixed object (wall, building, tunnel, etc.)

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Back Page Instructions

Transported to:/EMS Trip #/Seating Position/Passengers Injuried This section of the Investigating Officers Accident Report details information concerning Transported to:/EMS Trip #/Seating Position/Injuries.

Seating Position

Uni

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Uni

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Sex

Sea

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Pos

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Inju

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Eje

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Sou

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13 – Front row other 14 – Second row other 15 – Third row other 16 – Fourth row other 17 – Motorcycle passenger 18 – Pedalcycle passenger 19 – Bus passenger 20 – Trailing unit

21 – On vehicle exterior (non-trailing unit) 22 – Unenclosed cargo area 23 – Enclosed cargo area 24 – Sleeper section of cab (truck) 25 – Seating Position “1” NOT Operator 96 – Not applicable (Pedestrian) 97 – Other 99 – Unknown

Operator 1 2 3

4 5 6

7 8 9

10 11 12

UNIT 1 Transported to: EMS Trip #


PA

SS

EN

GE

RS

INJU

RIE

D

1. Name: Date of Birth

Address: Transported to: EMS Trip #







NOTE: Codes for Unit Type, Sex, Injury Status, Ejection, Source of Transport, Air Bag Deployed and Safety Equipment are located at the top of the back page of the overlay. Only one code should be used in each box.

1. Transported to: – Enter the name of the medical facility (doctor’s office, clinic, hospital) orfuneral home where the injured or killed person was taken in the “Transported to:” field.List the first place the person was taken. If not taken anywhere, enter “None”.

2. EMS Trip # – Enter the emergency medical services (EMS) trip number assigned to theinjured person transported.

3. Name and Address of Person Injured – Enter the full name and address of all injuredpassengers. This would include passengers in motor vehicles, bicycle passengers, railwaytrain passengers, etc. (See Appendix A for state codes)

4. Date of Birth of Person Injured – Enter the date of birth of the person in the personsinjured name field. Date of birth should be entered in the Month/Day/Year format.

5. Unit No. – Enter the number corresponding to the unit in which the injured person was apassenger.

1 2

6

3 4

5

7 8 9 10 11 12 13

21

6. Seating Position – Enter the seating position of the person identified for this unit. See codeson the back of form in the upper left hand side.

1 – Front row - left seat 2 – Front row - middle seat 3 – Front row - right seat 4 – Second row - left seat 5 – Second row - middle seat 6 – Second row - right seat 7 – Third row - left seat 8 – Third row - middle seat 9 – Third row - right seat 10 – Fourth row - left seat

11 – Fourth row - middle seat 12 – Fourth row - right seat 13 – Front row other 14 – Second row other 15 – Third row other 16 – Fourth row other 17 – Motorcycle passenger 18 – Pedalcycle passenger 19 – Bus passenger 20 – Trailing unit


1 Front row - left seat – Operators of: moped/motorcycle, snowmobile, bicycle, railway vehicle, animal (with rider), animal drawn vehicle, motor vehicle in transport with driver and motor vehicle used as equipment. Note- See code 25 for persons in the 01 seating position - in parked and driverless motor vehicles.

2 Front row – middle seat – Use this code for persons seated in the middle seat of the front row. If there are more than three persons seated side by side, use this code for all persons other than those seated on the far left and far right.

3 Front row - right seat 4 Second row - left seat 5 Second row – middle seat – Use this code for persons seated in the middle seat of the

second row. If there are more than three persons seated side by side, use this code for all persons other than those seated on the far left and far right.

6 Second row - right seat 7 Third row - left seat 8 Third row – middle seat – Use this code for persons seated in the middle seat of the third

row. If there are more than three persons seated side by side use this code for all persons other than those seated on the far left and far right.

9 Third row - right seat 10 Fourth row – left seat 11 Fourth row – middle seat – Use this code for persons seated in the middle seat of the

fourth row. If there are more than three persons seated side by side use this code for all persons other than those seated on the far left and far right.

12 Fourth row – right seat 13 Front row – other – This code should be used for persons lying on the first row seat or

lying on the floor in front of first row seat. 14 Second row – other – This code should be used for persons lying on the second row seat

or lying on the floor in front of second row seat. 15 Third row – other – This code should be used for persons lying on the third row seat or

lying on the floor in front of third row seat. 16 Fourth row – other – This code should be used for persons lying on the fourth row seat or

lying on the floor in front of fourth row seat. 17 Motorcycle passenger – Use this code for motorcycle passengers including motorcycle

sidecar passengers. 18 Pedalcycle passenger 19 Bus passenger – Use this code for all persons in buses, excluding the operator. 20 Trailing unit – in camper, utility trailer, semi-trailer, etc.

22

21 On vehicle exterior (non-trailing unit) – hood, running board, top, etc. 22 Unenclosed cargo area – pickup box 23 Enclosed cargo area – back of seat-less cargo van 24 Sleeper section of cab (truck) – This code is only applicable for tractor/semi-trailer vehicle

configurations with attached sleeper sections. 25 01 Seating position NOT operator – parked car with person in 01 seating position,

driverless motor vehicle with small child in 01 seating position 96 Not applicable – pedestrian 97 Other* – passengers of railway vehicle, snowmobile, moped, all terrain, animal drawn

vehicle and persons seated in vans with more than 4 rows. 99 Unknown

7 Unit Type – Code the type of unit for which information is being collected.

1 Motor vehicle in transport with driver 2 Motor vehicle - parked - A parked motor vehicle is a motor vehicle that is not in motion

or on a roadway (the normal driving portion of a trafficway). To be considered parked, the motor vehicle must have been outside the area designated as the roadway and not moving. If any portion of the motor vehicle outline (excluding open doors, mirrors, etc.) is on a roadway it is not parked.

3 Motor vehicle in transport without driver - not parked 4 Motor vehicle used as equipment (snowplow plowing, etc.) 5 Pedestrian 6 Pedalcycle 7 Railway vehicle 8 Animal (with rider) 9 Animal drawn vehicle

8 Sex – Enter the code indicating the sex of each person listed.

1 Male 2 Female 99 Unknown

9 Injury Status – Enter the code for the injury status which best describes the injuries resulting from the motor vehicle traffic accident for each person listed.

1 (K) Fatal – An injury which results in death. An injury caused death that occurs within 30 days of an accident is considered an accident fatality. 2 (A) Suspected Serious Injury – Any injury, other than a fatal injury, which prevents the injured person from walking, driving or normally continuing the activities the person was capable of performing before the injury occurred.

INCLUDED: Crush Injuries Significant burnsParalysis Severe lacerations Broken or distorted limbs Skull or chest injuries Abdominal injuries Unconsciousness at or when taken from scene

23

Unable to leave the accident scene without assistance EXCLUDED: Momentary unconsciousness

3 (B) Suspected Minor Injury – Any injury, other than a fatal injury or an incapacitating injury, which is evident to observers at the accident scene. INCLUDED: Lumps on head, abrasions, bruises, minor lacerations EXCLUDED: Limping (injury cannot be seen).

4 (C) Possible Injury – Any injury reported or claimed which is not a fatal injury, incapacitating injury, or non-incapacitating injury. INCLUDED: Momentary unconsciousness Claim of injuries not evident/visible Limping Nausea Hysteria Complaint of pain.

5 (O) No Apparent Injury

10 Ejection – Enter the code that describes the condition of each person with respect to ejection. Note that Code 96 – “not applicable” should be used for pedestrians, motorcycle, snowmobile, pedalcycle operators and passengers.

0 Not ejected 1 Ejected, Totally – Occupant’s body completely thrown from the motor vehicle as a

result of the accident. 2 Ejected, Partially – The location of an occupant’s body not completely thrown

from the motor vehicle as a result of the accident. 96 Not applicable (motorcycle, snowmobile, pedestrian, pedalcyclist, etc.) 99 Unknown

11 Source of Transport – Code the source that transported an injured person to a medical facility.

0 Not Transported 1 EMS 2 Law Enforcement 97 Other* 99 Unknown

12 Air Bag Deployed – Code the airbag deployment for each person. Note that Code 96 – “not applicable” should be used for pedestrians, motorcycle, snowmobile, and pedalcycle operators and passengers.

0 Not-deployed (if airbag is not installed or not available for a motor vehicle code “0” zero) 1 Deployed-front 2 Deployed-side 3 Deployed-other (knee, air belt, etc.)

24

4 Deployed-combination 96 Not applicable (motorcycle, snowmobile, pedestrian, pedalcyclist, etc.) 99 Unknown

13 Safety Equipment – Code the appropriate safety equipment used for each person. Indicate only protective devices that are being used.

0 None used 1 Lap belt only used 2 Shoulder harness only used 3 Lap belt and shoulder harness used 4 Helmet only – This code is appropriate for both operators and passengers of motorcycles,

mopeds, snowmobiles and pedalcyclists. 5 Eye protection only – This code is appropriate for both operators and passengers of

motorcycles, mopeds, snowmobiles and pedalcyclists. 6 Helmet and eye protection - This code is appropriate for both operators and passengers of

motorcycles, mopeds, snowmobiles and pedalcyclists. 7 Child/Youth restraint system used properly – Use this code, as an example, when the child

has been properly placed and secured in a child safety seat and the safety seat has be properly secured in the vehicle.

8 Child/Youth restraint system used, not properly – Use this code, as an example, when the child has been properly placed and secured in a child safety seat but the safety seat is not secured in the vehicle or when the safety seat is secured in the vehicle but the child is not secured in the safety seat.

9 Protective pads used (Non-Motorist Only) 10 Reflective clothing (Non-Motorist Only) 11 Lighting (Non-Motorist Only) 97 Other* 99 Unknown

Accident Diagram This section of the Investigating Officers Accident Report should be used to draw a picture that visually details how the accident occurred. The accident diagram, in conjunction with the accident narrative, describes the main events of the accident and shows the sequence of events prior to and during the accident. Draw an accident diagram according to the following guidelines. 1. Indicate North on the diagram by inserting an arrow in the circle provided. 2. Draw the trafficway layout at the accident scene. The diagram should show the lanes of each

roadway, shoulders, medians, roadsides, fence lines, etc. 3. Draw each unit (motor vehicle, bicycle driver, pedestrian, train, etc.) at the point of impact

with solid lines and number it to correspond with the unit numbers assigned on the front page of the report.

4. Indicate the direction from which each unit came with a solid arrow.

25

5. Draw a broken line from the point of impact to the final resting place for each unit. 6. Draw in any physical features of importance such as view obstructions, traffic signs/signals,

fixed objects, centerlines, no-passing zones, etc. 7. Indicate the names of all trafficways. 8. Include pertinent measurements such as length of skid marks and distance from centerline or

edge of roadway. 9. Indicate if a motor vehicle overturned, and if possible, the number of times. 10. The use of Northwestern University Traffic Institute Templates is recommended when they

are available. See examples of symbols below:

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Accident Narrative This section of the Investigating Officers Accident Report should be used to describe the main events of the accident and provide a time sequence to aid in the understanding of the accident diagram. Remember someone reading the accident report will not have the benefit of viewing the accident scene like the investigating officer does. When someone reads the accident narrative, the sequence of events in the accident should be clear. Use the following guidelines in writing the accident narrative. 1. Refer to vehicles, drivers, and other persons involved in the accident by the unit numbers

assigned to them on Front of the accident report. 2. There are a number of data elements on the OVERLAY which have the code “Other*”. The

OVERLAY instructs the officer to “explain in narrative” those data elements coded 97 Other*.

3. The narrative along with the diagram should include a description of the first injury or

damage causing event as well as the manner in which the units collided if appropriate. 4. If more space is needed, attach an extra sheet. Witness This section of the Investigating Officers Accident Report should be used to acquire information concerning witnesses who saw the accident occur.

Witness (Last, First, Middle) Phone No Address City State Zip

1. Witness (Last, First, Middle): – Enter the Witness’s full name.

2. Phone No – Enter the Witness’s complete telephone number.

3. Address, City, State and Zip – Enter the Witness’s complete address, city, state and zip

code. (See Appendix A for state codes)

Officer This section of the Investigating Officers Accident Report is used to enter information concerning the officer that responded to the accident.

Officer Filing Report & ID No. Date Notified Time Notified Date Arrived Time Arrived

Agency Name

Agency Type Highway Patrol Sheriff Department City Police BIA Tribal Police Other

Officer Approving Report

Date Approved Red Tag # Unit 1_______________

Agency Use

Investigation made at scene? Yes No

Photos Taken? Yes No Unknown Unit 2_______________

1. Officer Filing Report & ID No. – Enter the name and identification number of the law

enforcement officer filing the accident report. The officer filing the report will be the

1 2 3

1 2 3

4 5

6 7

8 9

11 10

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investigating officer when only one officer investigates an accident. In cases where an accident is investigated by multiple officers from the same agency or by officers from more than one agency, the name entered should be for the officer who has PRIMARY responsibility for the report. Only one name should be entered in this area.

2. Date Notified/Time Notified – Enter the date and time a law enforcement agency was

notified of the accident occurrence. In cases where there were multiple notifications (e.g. Sheriff and Highway Patrol both notified), enter the date and time of the first notification. Date should be entered in the Month/Day/Year format. Time MUST be entered in a 24 hour clock format. Note that Midnight = “0000”. Please note! For accident reporting, 2400 is NOT a valid time. One minute after midnight is entered as “0001”.

3. Date Arrived/Time Arrived – Enter the date and time a law enforcement agency arrived at

the accident scene. In cases where multiple agencies are involved in an accident investigation, enter the date and time that the first agency arrived. Date should be entered in the Month/Day/Year format. Time MUST be entered in a 24 hour clock format. Note that Midnight = “0000”. Please note! For accident reporting, 2400 is NOT a valid time. One minute after midnight is entered as “0001”.

FOR ACCIDENTS NOT INVESTIGATED AT THE SCENE: Enter “NA” not applicable for Date Arrived, and enter “NA” for Time Arrived.

4. Agency Name – Enter the name of the agency filing the report. This is the complete agency name, e.g., Hughes County Sheriff. Do NOT just enter agency type.

5. Agency Type – Check the box to indicate the agency type filing the report.

6. Officer Approving Report – Enter the name of the law enforcement officer who approved

the accident report.

7. Date Approved – Enter the date on which the accident report was approved using the mm/dd/yy format.

8. Investigation made at scene? – Indicate whether or not the investigation was made at the

scene by checking the “yes” or “no” box.

9. Photos Taken? – Indicate whether or not photographs of the accident scene were taken by checking the “Yes”, “No” or “Unknown” box. It is the responsibility of the law enforcement agency taking photographs to retain them. Photographs should NOT be submitted with the accident report.

10. Red Tag # – Enter the number of the red tag issued for the damaged motor vehicle.

11. Agency Use – This space is available for the law enforcement agency’s use.

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Front Page Overlay Instructions Place the Front Page Overlay over the Front Page of the Accident Report. There are data elements on the Front Page Overlay numbered 1 through 19. MAKE SURE the arrows on the overlay line up with the corresponding boxes in the left and right margins of Front Page of the accident report. Only one code should be used in each box.

Vehicle Level Information: Data elements 1 thru 10 and 13 thru 19 Accident Level Information: Data elements 11 and 12 Vehicle Configuration (1)

Vehicle Configuration 10 Moped 22 Tractor/doubles

1 Passenger car 11 All terrain vehicle/4 wheeler 23 Tractor/triples 2 SUV (sport utility/suburban) 12 Snowmobile 24 Tractor/mobile home 3 Mini-van/passenger van with seats for 8 or less, 13 Farm machinery 97 Other*

including driver 14 Heavy equipment 99 Unknown 4 Cargo van - GVWR 10,000 lbs or less 15 Light truck (2-axles, 4 tires) 5 Cargo van - GVWR 10,001 lbs or more 16 Single-unit truck (2 axle, 6 tires) GVWR 10,000 lbs or less 6 Van/Bus with seats for 9-15 people, including driver 17 Single-unit truck (2-axle, 6 tires) GVWR 10,001 lbs or more 7 Van/Bus with seats for 16 or more people, 18 Single-unit truck (3 or more axles)

including driver 19 Truck pulling trailer(s) - GCWR 10,001 lbs or more 8 Motor home 20 Truck tractor only (bobtail) 9 Motorcycle 21 Tractor/semi-trailer

USE ONLY WHEN THE UNIT IS A MOTOR VEHICLE Enter the code which best indicates the general style of the accident involved motor vehicle. The coding box should be crossed out with an “X” or “-“ when the unit is not a motor vehicle. Codes: 1 Passenger car 2 SUV (sport utility/suburban) – Sport Utility Vehicles for this manual are defined by the

models listed as examples. Some examples are: Toyota 4Runner, Nissan Murano, Chrysler Pacifica, Honda Pilot, and Mitsubishi Endeavor, Lexus RX 330, Infiniti FX, Cadillac SRX, Ford Explorer and Expedition, GMC Jimmy/Envoy, Chevrolet Blazer, Buick Rendezvous, Chevrolet Suburban and Tahoe, and others.

3 Mini-van/passenger van with seats for 8 or less, including driver 4 Cargo van - GVWR 10,000 lbs or less 5 Cargo van - GVWR 10,001 lbs or more) 6 Van/Bus with seats for 9 -15 people, including driver 7 Van/Bus with seats for 16 or more people, including driver 8 Motor Home 9 Motorcycle – Note! Some vehicles which look like mopeds are officially classified as

motorcycles. See moped category. 10 Moped – Only vehicles OFFICIALLY classified as mopeds should be included in this

category. A vehicle officially classified as a moped meets ALL of the following criteria: Motor driven cycle equipped with two or three wheels, if combustion engine is used the maximum piston or rotor displacement shall be fifty cubic centimeters, power drive system that functions directly or automatically only, not requiring clutching or shifting after the drive system is engaged. (See definition SDCL 32-20-1)

11 All terrain vehicle / 4 wheeler 12 Snowmobile

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13 Farm machinery – Examples include farm tractors, combines, motorized windrowers, motorized spraying equipment, etc.

14 Heavy equipment – Examples include motor graders, end loaders, tractors with backhoes and/or loaders mounted, truck mounted cranes and backhoes, scrapers, etc.

15 Light truck (2-axle, 4 tires) – Includes vehicles of pickup design. 16 Single-unit truck (2-axle, 6 tires) GVWR 10,000 lbs or less) 17 Single-unit truck (2-axle, 6 tires) GVWR 10,001 lbs or more) Note – If the vehicle fits this

configuration use “17” even if this vehicle is pulling a trailer(s). DO NOT use code “19”. Please see comments under code “19”. Code “19” is to be used for those light trucks with a GVWR of 10,000 lbs or less which are pulling a trailer or trailers.

18 Single-unit truck (3 or more axles) Note – If the vehicle fits this configuration use “18” even if this vehicle is pulling a trailer(s). DO NOT use code “19”. Please see comments under code “19”. Code “19” is to be used for those light trucks with a GVWR of 10,000 lbs or less which are pulling a trailer or trailers.

19 Truck pulling trailer(s) - GCWR 10,001 lbs or more – This code is to identify those light trucks, code = “15” and single-unit trucks (2-axle, 6 tires) GVWR 10,000 lbs or less, code = “16” that when combined with trailer(s) have a gross combined weight rating (GCWR) of 10,001 lbs or more. GCWR is derived by combining the GVWR of the power unit and all trailers attached to the power unit. Do NOT use code “19”, truck pulling trailers if vehicle configuration is code “17” or “18”, even if vehicle configuration “17” or “18” is pulling a trailer or trailers. Also do NOT use “19” in place of codes “20”, “21”, “22”, “23”, or “24”.

20 Truck tractor only (bobtail) 21 Tractor/semi-trailer 22 Tractor/doubles 23 Tractor/triples 24 Tractor/mobile home 25 Other* This category should ONLY be used when one of the categories listed above cannot

adequately describe the motor vehicle configuration. If this category is used, it MUST be explained in the accident narrative.

99 Unknown Trailer Type (2)

Trailer Type 0 No trailer/attachment 8 Small Utility (one axle) 1 Semi-trailer/double/triple 9 Large Utility (2 or more axles) 2 Pup trailer 10 Combination (camper, boat, etc.) 3 Mobile home 11 Farm trailer (gravity box, 4 Camping trailer hay rack, etc) 5 Boat trailer 12 Farm equipment (disk, plow, etc.) 6 Horse trailer 97 Other* 7 Towed motor vehicle 99 Unknown

USE ONLY WHEN THE UNIT IS A MOTOR VEHICLE Enter the code that describes the type of trailer or attachment attached to the motor vehicle. The coding box should be crossed out with an “X” when the unit is pedestrian, pedalcycle, railway vehicle, animal with rider, or animal drawn vehicle. Codes: 0 No trailer/attachment – Use this code if the unit does not have a trailer or attachment of any type. 1 Semi-trailer/double/triple – When vehicle configuration is coded 21 tractor/semi-trailer, 22

tractor/doubles, or 23 tractor/triples this code must be used. 2 Pup trailer – A small version of the single-unit truck used to haul material like the truck. Example: a

gravel truck pulling a smaller pup trailer.

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3 Mobile home 4 Camping trailer 5 Boat trailer 6 Horse trailer 7 Towed motor vehicle 8 Small utility (one axle) 9 Large utility (2 or more axles) 10 Combination (camper and boat, etc.) 11 Farm trailer (gravity box, hay rack, etc.) 12 Farm equipment (disk, plow, etc.) 97 Other* - Use this code ONLY if one of the other trailer type codes given above does not adequately

describe the trailer/attachment. If this code is used, it MUST be explained in the narrative. 99 Unknown Cargo Body Type (3)

Cargo Body Type 0 No cargo body 7 Dump 1 Bus 8 Concrete mixer 2 Van/enclosed box 9 Auto transporter 3 Hopper (Grain/chips/gravel) 10 Garbage/refuse 4 Pole 97 Other* 5 Cargo tank 99 Unknown 6 Flatbed

This data element must be collected for those units meeting the commercial vehicle criteria listed below:

IF the vehicle meets one or more of the following: • The vehicle has a Gross Combined Weight Rating (GCWR) of 10,001 or more pounds. • The vehicle displays a hazardous material placard. • The vehicle is designed to transport 9 or more people, including driver.

AND, the accident resulted in one or more of the following: • A fatality occurred. • An injury requiring transportation for immediate medical attention. • Any vehicle was disabled requiring a towaway from the scene. Note – please review

instructions for data field “Vehicle Towed?”. Enter the code that describes the cargo body type of the commercial motor vehicle. The coding box should be crossed out with an “X” when the unit is not a vehicle meeting the motor carrier data requirements. Note – Some light trucks of the pickup design may have a GVWR of 10,001 lbs. or more but should be coded as 00 – No cargo body. Codes: 0 No cargo body – Includes placarded cars, truck tractor only, pickups, etc. 1 Bus 2 Van/enclosed box 3 Hopper (Grain/chips/gravel) 4 Pole – a pole trailer is used to carry logs or other long objects. The unloaded trailer resembles an

extended pole with no flat surface as with a flatbed trailer. 5 Cargo tank 6 Flatbed

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7 Dump 8 Concrete mixer 9 Auto transporter 10 Garbage/refuse 97 Other 99 Unknown Initial Point of Impact (4) / Most Damaged Area (5)

Initial Point of Impact Most Damaged Area 0 No Damage 13 Top (roof) 14 Undercarriage 15 Non-Collision 99 Unknown

Refer to the diagram that represents a vehicle or combination of vehicles and enter the codes that best indicate the Initial Point of Impact where the first damage occurred on the vehicle and the area of the unit that was the Most Damaged Area. Note – The only time the actual impact points would be coded would be if the vehicle incurred damage from impacting against a vehicle or object at any time during the accident, whether an overturn occurs or not. If the only event is an overturn, the accident is considered a non-collision and the impact points are coded 15. Hitting the ground is not regarded as an impact.

Note – The diagram appears to represent a car. However, it can be adapted for any type of vehicle or combination. For example; if the vehicle is a truck tractor/semi-trailer combination and the first damage was close to the rear on the left side of the semi-trailer, the correct Initial Point of Impact code will be “7”. Codes: 0 No Damage 12-point clock diagram (See Appendix C) 13 Top (roof) 14 Undercarriage – Wheel impacts are included in undercarriage. 15 Non-collision – Overturning, jackknife, fire, etc. 99 Unknown

1 2 3 4 5

7 8 9 10 11

12

6 Front

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Underride/Override (6)

Underride/Override 0 No underride or override 1 Underride, compartment intrusion 2 Underride, no compartment intrusion 3 Underride, compartment intrusion unknown 4 Override, motor vehicle in transport 5 Override, other motor vehicle

99 Unknown if underride or override

Enter the Underride/Override code. An underride refers to a motor vehicle sliding under another motor vehicle during the accident. An override refers to this motor vehicle riding up over another motor vehicle. Either can occur with a parked motor vehicle. This data element refers to the vehicle doing the override or which underrides another vehicle. Examples, (1) a car underriding the side of a truck would be coded for the car. You would in-turn code override for the truck. (2) a truck changes lanes and turns over a car traveling along side the truck, you would code override for the truck and would in this case code underride for the car.

Codes: 0 None - No underride or override 1 Underride, compartment intrusion 2 Underride, no compartment intrusion 3 Underride, compartment intrusion unknown 4 Override, motor vehicle in transport 5 Override, other motor vehicle (parked) 99 Unknown if underride or override

Alcohol Use (7)

Alcohol Use 0 None used 99 Unknown 1 Alcohol used

COLLECT FOR UNIT OPERATOR (THOSE PERSONS WHO ARE ASSIGNED SEATING POSITION CODE 1) AND PEDESTRIANS

Investigating officer’s assessment of whether alcohol was used by the unit operator or pedestrian.

NOTE: An indication of alcohol use in this area does not necessarily imply that alcohol use was a contributing circumstance. Alcohol use should be coded here whether or not it is coded as a contributing circumstance.

Codes: 0 None used. This code should be used if there is no alcohol use by the unit operator

(including pedalcyclist driver) or pedestrian. 1 Alcohol used. This code should be used if there is reasonable evidence to suggest that the

unit operator(including pedalcyclist driver) or pedestrian has alcohol in his/her bloodstream. Use of this code does not necessarily mean or imply a DUI situation. It should be used in all circumstances when evidence suggests drinking, which includes both DUI and non-DUI.

99 Unknown. Use this code when it is impossible to determine whether or not there is alcohol in the unit operator(including pedalcyclist driver) or pedestrian’s bloodstream.

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Alcohol Test Status (8)

Alcohol Test Status Test results (list actual BAC) 92 Test given, contaminated sample/unusable

90 Test refused 93 Test given, but unobtainable at time report filed 91 Test not given 99 Unknown

COLLECT FOR UNIT OPERATOR (THOSE PERSONS WHO ARE ASSIGNED SEATING POSITION CODE 1) AND PEDESTRIANS If a Blood Alcohol Concentration test or a Digital PBT test was administered, the results of either test should be entered in the space provided. A decimal point is implied before the first digit of the number entered. For example, a test result of “0.15” should be entered as “15”. For law enforcement agencies without breath testing equipment, results of chemical tests will not be available immediately. HOLD THE ACCIDENT REPORT UP TO 5 WORKING DAYS TO ALLOW FOR THE RESULTS OF CHEMICAL TESTS TO BE RETURNED. If the results of a chemical test are not available in 5 working days, the report should be submitted without the BAC value. If a test was administered and the report is submitted without the results, “93” should be coded in the space provided for test results. The following additional codes may be used for this data element. Codes: Test results (list actual BAC) 90 Test refused 91 Test not given 92 Test given, contaminated sample/unusable 93 Test given, but unobtainable at time report filed 99 Unknown Drug Use (9)

Drug Use 0 None used 99 Unknown 1 Drugs used

COLLECT FOR UNIT OPERATOR (THOSE PERSONS WHO ARE ASSIGNED SEATING POSITION CODE 1) AND PEDESTRIANS Investigating officer’s assessment of whether drugs were used by the unit operator or pedestrian.. NOTE: An indication of drug use in this area does not necessarily imply that drug use was a contributing circumstance. Drug use should be coded here whether or not it is coded as a contributing circumstance. Codes: 0 None used. This code should be used if there is no drug use by the unit operator or

pedestrian. 1 Drugs used. This code should be used if there is reasonable evidence to suggest that the unit

operator or pedestrian. have drugs in his/her bloodstream. Use of this code does not necessarily mean or imply a DUI situation. It should be used in all circumstances when

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evidence suggests drug use, which includes both DUI and non-DUI. Note – This pertains only to drugs which could possibly affect driving performance. Drugs of this type include both legal drugs (prescription and over the counter) and illegal drugs. Examples of drugs which would be included are barbiturates, tranquilizers, cold and hay fever medications, marijuana, PCP, LSD, cocaine, etc. Examples of drugs which are not included in this category are aspirin, vitamins, etc.

99 Unknown. Use this code when it is impossible to determine whether or not there are drugs in the unit operator or pedestrian’s bloodstream

Drug Test Status (10)

Drug Test Status 1 Test refused 5 Test given, contaminated sample/unusable 2 Test not given 6 Test given, but unobtainable at time report filed 3 Test given, no drugs reported 99 Unknown 4 Test given, drugs reported

COLLECT FOR UNIT OPERATOR (THOSE PERSONS WHO ARE ASSIGNED SEATING POSITION CODE 1) AND PEDESTRIANS If a drug test was administered, HOLD THE ACCIDENT REPORT UP TO 5 WORKING DAYS TO ALLOW FOR THE RESULTS OF THE TEST TO BE RETURNED. If a test was administered and the report is submitted without the results, “6” should be coded in the space provided for test results. The following additional codes may be used for this data element. Codes: 1 Test refused 2 Test not given 3 Test given, no drugs reported 4 Test given, drugs reported 5 Test given, contaminated sample/unusable 6 Test given, but unobtainable at time of report filed 99 Unknown

Work Zone Data Collection Comments – The accurate recording of accidents which occur in work zones is very important in the development of countermeasures to reduce accidents and severity for both the traveling public and workers. Due to the detail of work zone data collection it is strongly recommended to review the instructions whenever reporting accidents which occur in and around work zone areas. Work zone data collection involves four (4) data fields: Work Zone Related? Workers Present? Work Zone Type(code box 11) and Work Zone Location(code box 12). The first data field, “Work Zone Related?” is a question. If the answer to question is NO then the other 3 data fields are to be recorded as 96 – Not applicable. The first data field, “Work Zone Related?” is somewhat misleading because of the word related. The word related refers to collecting those accidents before the first warning sign or after the last exit sign if the accident resulted from an activity, behavior or control related to the movement of the traffic units through the work zone. ALL work zone accidents which occur between the first warning sign and the final termination area sign are to be recorded as work zone accidents. It is recommended to view the Diagram of a Work Zone Area – Appendix B.

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Work Zone Type (11)

Work Zone Type 96 Not applicable 3 Work on shoulder or median 97 Other*

1 Lane closure 4 Intermittent or moving work 99 Unknown 2 Lane shift/crossover

An accident that occurs in or related to a construction, maintenance, or utility work zone, whether or not workers were actually present at the time of the accident. ‘Work zone related’ accidents may also include those involving motor vehicles slowed or stopped because of the work zone, even if the first harmful event occurred before the first warning sign. (See Appendix B for diagram of work zone areas.) Codes: 96 Not applicable 1 Lane closure 2 Lane shift/crossover 3 Work on shoulder or median 4 Intermittent or moving work 97 Other 99 Unknown Work Zone Location (12)

Work Zone Location 96 Not applicable

1 Before the first work zone warning sign 2 Advance warning area (after the first warning sign but before the work area) 3 Transition area (where lanes are shifted or tapered for lane closure) 4 Activity area (adjacent to actual work area, whether workers and equipment were present or not) 5 Termination area (after the activity area but before traffic resumes normal conditions)

99 Unknown

An accident that occurs in or related to a construction, maintenance, or utility work zone, whether or not workers were actually present at the time of the accident. ‘Work zone related’ accidents may also include those involving motor vehicles slowed or stopped because of the work zone, even if the first harmful event occurred before the first warning sign. (See Appendix B for diagram of work zone areas.) Codes: 96 Not applicable 1 Before the first work zone warning sign 2 Advance warning area (after the first warning sign but before the work area) 3 Transition area (where lanes are shifted or tapered for lane closure) 4 Activity Area (adjacent to actual work area, whether workers and equipment were present or not) 5 Termination area (after the activity area but before traffic resumes normal conditions) 99 Unknown

COLLECT “TRAVEL DIRECTION BEFORE ACCIDENT” FOR UNIT TYPES: MOTOR VEHICLE IN TRANSPORT WITH DRIVER, MOTOR VEHICLE PARKED, MOTOR VHICLE IN TRANSPORT WITHOUT DRIVER, MOTOR VEHICLE USED AS EQUIPMENT AND PEDALCYCLE

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Travel Direction Before Accident (13)

Travel Direction Before Accident 1 Northbound 2 Southbound 3 Eastbound 4 Westbound 5 Not on roadway (also use for parked motor vehicle)

96 Not applicable (immobile from previous accident, stuck, etc).

99 Unknown

The direction of a vehicle’s travel on the roadway before the accident. Notice that this is not a compass direction, but a direction consistent with the designated direction of the road. For example, the direction of a state designated north-south highway must be either northbound or southbound even though a vehicle may have been traveling due east as a result of a short segment of the highway having an east-west orientation.

Codes: 1 Northbound 2 Southbound 3 Eastbound 4 Westbound 5 Not on roadway (also use for parked motor vehicle) Note – If a vehicle is STOPPED in traffic ON a

ROADWAY do NOT use this code. Indicate the travel direction of the vehicle before it stopped on the roadway.

96 Not applicable (immobile from previous accident, stuck, etc) 99 Unknown

Driver Contributing Circumstances (14)

Driver Contributing Circumstances 0 None 16 Running off road 1 Failed to yield to vehicle 17 Swerving or avoiding due to wind, slippery 2 Failed to yield to pedestrian surface, vehicle, object, non-motorist, etc. 3 Disregarded traffic signs or signals 18 Over-correcting/over-steering 4 Exceeded posted speed limit 19 Fatigued/asleep 5 Driving too fast for conditions 20 Drinking 6 Improper turn 21 Drugs-medication 7 Wrong side or wrong way 22 Drugs-Other 8 Improper signal or failure to signal 23 Illness (heart attack, stroke, etc.) 9 Improper lane change 24 Physical impairment

10 Improper passing 25 Illegally in roadway 11 Improper start from parked position 26 Cell phone 12 Improper parking 27 Other* electronic device (list in narrative) 13 Improper backing 28 Distracted (list distraction in narrative) 14 Followed too closely 97 Other* 15 Failure to keep in proper lane 99 Unknown

Two codes should be entered for each motor vehicle with a driver. If there are less than two contributing circumstances, “0” should be entered in the remaining boxes. Note that some of the codes listed below overlap with each other in certain situations. Since up to two contributing circumstances may be coded, two codes which overlap in a particular accident situation can both be entered if necessary. If there are more than two codes which fit the accident situation, use the two which BEST describe the contributing circumstances for the accident. Codes: 0 None

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1 Failed to yield to vehicle 2 Failed to yield to pedestrian 3 Disregarded traffic signs or signals 4 Exceeded posted speed limit – This code should be used when a vehicle was exceeding the

legal speed limit. The legal limit is NOT to be construed as advisory speed limits such as those posted on curve signs.

5 Driving too fast for conditions – Use this code when excessive speed contributed to causing the accident but the speed was less than the legal limit. This code should be used in driving too fast for conditions situations, such as adverse weather. This code is also appropriate for vehicles exceeding advisory speed limits on curves, etc. but not the legal speed limit.

6 Improper turn 7 Wrong side or wrong way - Use this code for situations where a vehicle is involved in a

collision on the wrong side of the road and when a vehicle runs off the road on the wrong side of the road.

8 Improper signal or failure to signal 9 Improper lane change 10 Improper passing 11 Improper start from parked position 12 Improper parking 13 Improper backing 14 Followed too closely 15 Failure to keep in proper lane 16 Running off road 17 Swerving or avoiding due to wind, slippery surface, vehicle, object, non-motorist, etc. 18 Over-correcting/over-steering 19 Fatigued/asleep 20 Drinking 21 Drugs – medication 22 Drugs – other 23 Illness (heart attack, stroke, etc.) 24 Physical impairment 25 Illegally in roadway 26 Cell phone 27 Other electronic device (list in narrative) 28 Distracted (list distraction in narrative) 97 Other* Use this code only if the contributing circumstances cannot be adequately described

by the other codes listed above. If code “97” Other is used, it MUST be explained in the accident narrative.

99 Unknown

Vehicle Contributing Circumstances (15)

Vehicle Contributing Circumstances 14 Cargo 0 None 7 Headlights 15 Fuel

1 Brakes 8 Signal

16 Mirrors 2 Steerin

9 Tail lights 17 Wipers

3 Power train 10 Horn 18 Body, doors, hood 4 Suspension 11 Windows/Windshiel

97 Other*

5 Tires 12 Wheels 99 Unknown 6 Exhaus

13 Truck coupling / trailer hitch / safety chains

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USE ONLY WHEN THE UNIT TYPE IS A MOTOR VEHICLE IN TRANSPORT WITH DRIVER, MOTOR VEHICLE IN TRANSPORT WITHOUT DRIVER, AND MOTOR VEHICLE USED AS EQUIPMENT Enter the vehicle contributing circumstances for each motor vehicle. The coding box should be crossed out with an “X” when the unit is a pedalcycle, pedestrian, motor vehicle parked, railway vehicle, animal (with rider) and animal drawn vehicle. Codes: 0 None 1 Brakes 2 Steering 3 Power Train 4 Suspension 5 Tires 6 Exhaust 7 Headlights 8 Signal Lights 9 Tail Lights 10 Horn 11 Windows / windshield 12 Wheels 13 Truck coupling / trailer hitch / safety chains 14 Cargo 15 Fuel System 16 Mirrors 17 Wipers 18 Body, doors, hood 97 Other 99 Unknown

Vehicle Maneuver (16)

Vehicle Maneuver 1 Straight ahead 7 Making U-turn 13 Parking maneuver 2 Backing 8 Leaving traffic lane 14 Immobile from previous accident 3 Changing lanes 9 Entering traffic lane 15 Parked 4 Overtaking/passing 10 Slowing in traffic lane 97 Other* 5 Turning right 11 Stopped in traffic lane 99 Unknown 6 Turning left 12 Starting in traffic lane

USE ONLY WHEN THE UNIT IS A MOTOR VEHICLE Enter the code which BEST describes the maneuver of the motor vehicle just prior to the accident. Note that there may be situations in which more than one code describes the vehicle maneuver just prior to the accident. That is, in a few special situations the codes listed below may overlap somewhat. If this is the case, choose the code which BEST describes the maneuver and provide additional detail in the narrative. The coding box should be crossed out with an “X” or “-“ when the unit is a bicycle driver, pedestrian, etc.

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Codes: 1 Straight ahead – This code should be used for vehicles traveling straight ahead on straight

trafficways and vehicles following the curvature of curved trafficways. 2 Backing – A start from a parked or stopped position in the direction of the rear of the motor vehicle. 3 Changing lanes – Shift from one traffic lane to another traffic lane moving in the same direction. 4 Overtaking/passing – A motor vehicle that moves from behind a motor vehicle to in front of the

same motor vehicle or is in the process of making this maneuver. 5 Turning right – Use only when in the actual process of executing a turn at an intersection,

interchange, driveway access, etc. Do NOT code turning if a vehicle is stopped in traffic waiting to initiate a turn. NOTE - vehicles traveling on curved trafficways should be coded “Straight ahead”.

6 Turning left – Use only when in the actual process of executing a turn at an intersection, interchange, driveway access, etc. Do NOT code turning if a vehicle is stopped in traffic waiting to initiate a turn. NOTE - vehicles traveling on curved trafficways should be “Straight ahead”

7 Making U-turn 8 Leaving traffic lane – A motor vehicle moving outside the travel lane. 9 Entering traffic lane – A motor vehicle moving into the travel lane. 10 Slowing in traffic lane 11 Stopped in traffic lane – A vehicle stopped in traffic lane is defined as a vehicle, which is stopped on

the trafficway in an area normally used for vehicle travel (i.e. outside a parking lane). Stopped in traffic lane includes but is not limited to motor vehicles legally stopped for a stop sign or signal, motor vehicles stopped to turn PRIOR to initiating a turn, motor vehicles stopped in traffic due to a slow down in traffic ahead, and motor vehicles illegally stopped in a traffic lane. A vehicle stopped in traffic may or may NOT have a driver and the vehicle engine may or may NOT be running. Most “double parked” vehicles are actually stopped in traffic rather than parked.

12 Starting in traffic lane 13 Parking maneuver – Note that “parking maneuver” implies MOVEMENT in an area normally

reserved for parking. The engine of the vehicle must be running. If this code is used, the vehicle must have a driver.

14 Immobile from previous accident 15 Parked – Note that “parked” implies STOPPED in an area normally reserved for parking. The

engine of a parked vehicle may or may NOT be running. Parked vehicles do not have drivers, even if someone is sitting behind the wheel. Note that “double parked” vehicles are considered stopped in traffic. (See Code “11” – “Stopped in traffic lane” for further explanation.)

97 Other* – This code should be used ONLY if one of the other codes listed above does not adequately describe vehicle maneuver. If this code is used, it MUST be explained in the accident narrative.

99 Unknown

Traffic Control Device Type (17)

Traffic Control Device Type 0 No controls 7 Railway crossing signal with gate 1 Traffic control signal 8 Railway crossing with signal 2 Flashing traffic control signal 9 Railway crossing with crossbuck only 3 School zone signs 10 Traffic control person 4 Stop sign 97 Other* 5 Yield sign 99 Unknown 6 Warning sign

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USE ONLY WHEN THE UNIT TYPE IS A MOTOR VEHICLE IN TRANSPORT WITH DRIVER, MOTOR VEHICLE IN TRANSPORT WITHOUT DRIVER, AND MOTOR VEHICLE USED AS EQUIPMENT COLLECT FOR EACH VEHICLE LISTED ABOVE NOT FOR OVERALL ACCIDENT

Enter the code that describes the traffic control device at the scene of the accident that regulates this unit. Note that this data element is designed to collect information about traffic controls at the scene of the accident WITHOUT regard to whether or not a traffic control (or malfunction thereof) was related to the accident. Codes: 0 No controls – This code should be used in all situations when no FUNCTIONING traffic

controls are present, including situations where existing controls are knocked down, missing, or malfunctioning.

1 Traffic control signal – Controls traffic movements by illuminating systematically, a green, yellow, or red light

2 Flashing traffic control signal – This code should be used for controls which are designed only as flashing signals AND for stop and go signals which are in a flash cycle at the time of the accident.

3 School zone signs – Signs which change the speed limit on roads adjacent to a school on school days; signs which give advance warning of a school; and signs which warn of children crossing the road.

4 Stop sign – A six-sided red sign with "STOP" on it, requiring motor vehicles to come to a full stop and look for on-coming traffic before proceeding with caution.

5 Yield sign – Three-sided signs that require motor vehicles to give way to other vehicles. 6 Warning sign – Warn traffic of existing or potentially hazardous conditions on or adjacent to

a road. 7 Railway crossing signal with gate – An intersection between a roadway and train tracks

which cross each other at the same level (Grade) with a signal and gate that warns of on-coming trains or train tracks crossing the roadway.

8 Railway crossing with signal – An intersection between a roadway and train tracks which cross each other at the same level (Grade) with only a signal that warns of on-coming trains or train tracks crossing the roadway.

9 Railway crossing with cross buck only – An intersection between a roadway and train tracks which cross each other at the same level (Grade) with only a cross buck that warns of on-coming trains or train tracks crossing the roadway.

10 Traffic control person – flagger, law enforcement officer, crossing guard 97 Other* – This code should ONLY be used when one of the other codes listed above does not

adequately describe the traffic control device at the accident scene. If this code is used, it MUST be explained in the accident narrative. Note that curve signs and speed signs are NOT included in this category

99 Unknown

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Vision Contributing Circumstances (18)

Vision Contributing Circumstances 0 None 8 Motor vehicle (including 1 Weather condition load) not parked 2 Physical obstruction 9 Buildin

3 Windshield or other window obscured 10 Signs, billboards, etc. by frost, snow, mud, etc 11 Glare

4 Snow bank 97 Other* 5 Trees, crops, bushes, other vegetation 99 Unknown 6 Guardrail/barrie

7 Motor Vehicle (including load) parked

USE ONLY WHEN THE UNIT TYPE IS A MOTOR VEHICLE IN TRANSPORT WITH DRIVER, MOTOR VEHICLE IN TRANSPORT WITHOUT DRIVER AND MOTOR VEHICLE USED AS EQUIPMENT COLLECT FOR EACH VEHICLE INDICATED ABOVE NOT FOR OVERALL ACCIDENT Enter the code describing the vision obscurity that contributed to causing the accident for this VEHICLE. Codes: 0 None 1 Weather conditions 2 Physical obstruction 3 Windshield or other window obscured by frost, snow, mud, etc. 4 Snow bank 5 Trees, crops, bushes, other vegetation 6 Guardrail / barrier 7 Motor Vehicle (including load) parked 8 Motor Vehicle (including load) not parked 9 Building 10 Signs, billboards, etc. 11 Glare 97 Other* – This code should only be used if one of the other codes listed above does not

adequately describe the vision obscurity contributing to the accident. If this code is used, it must be explained in the accident narrative.

99 Unknown

Road Contributing Circumstances (19)

Road Contributing Circumstances 0 None 1 Road surface condition (wet, icy, snow, slush, etc.) 2 Debris 3 Rut, holes, bumps 4 Work zone (construction/maintenance/utility) 5 Worn, travel-polished surface 6 Obstruction in roadway 7 Traffic control device inoperative, missing or obscured 8 Pedestrian, bicyclists, other non-occupants in road 9 Shoulders (none, low, soft, high) 10 Non-highway work 11 Animal in roadway 12 Non-contact vehicle caused evasive action 97 Other* 99 Unknown

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USE ONLY WHEN THE UNIT TYPE IS A MOTOR VEHICLE IN TRANSPORT WITH DRIVER AND MOTOR VEHICLE USED AS EQUIPMENT COLLECT FOR EACH VEHICLE INDICATED ABOVE NOT FOR OVERALL ACCIDENT Enter the code describing the road condition that contributed to the occurrence of the accident for this VEHICLE.

Codes: 0 None 1 Road surface condition (wet, icy, snow, slush, etc.) 2 Debris 3 Rut, holes, bumps 4 Work zone (construction/maintenance/utility) 5 Worn, travel-polished surface 6 Obstruction in roadway 7 Traffic control device inoperative, missing or obscured 8 Pedestrian, bicyclists, other non-occupants in road 9 Shoulders (none, low, soft, high) 10 Non-highway work – Maintenance or other types of work occurring near or in the trafficway

but not related to the trafficway. 11 Animal in roadway 12 Non-contact vehicle caused evasive action 97 Other* Use this code ONLY if one of the other codes listed above does not adequately

describe the “other” contributing circumstance. If this code is used it MUST be explained in the accident narrative.

99 Unknown

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Back Page Overlay Instructions Place the Back Page Overlay over the Back Page of the Accident Report. There are data elements on the Back Page Overlay lettered A through L. MAKE SURE the arrows on the overlay line up with the corresponding boxes in the left and right margins of Back Page of the accident report. Only one code should be used in each box. Note: Instructions for “Sequence of Events/Most Harmful Event/First Harmful Event” are provided in the Front Page of the accident report section. Instructions for “Driver and Persons Injured” are provided in the Back Page of the accident report section.

Accident Level Information: Data elements A thru F and J thru L Vehicle Level Information: Data elements G thru I Manner of Collision (With motor vehicle in transport) (A) Enter the code to identify the manner in which two motor vehicles in transport initially came together without regard to the direction of force. This data element refers only to accidents where the first harmful event involves a collision between two motor vehicles in transport.

Manner of Collision (With motor vehicle in transport) 0 No collision between 2 MV in transport 4 Sideswipe, same direction 1 Rear-end (Front-to-rear) 5 Sideswipe, opposite direction 2 Head-on (Front-to-front) 6 Rear-to-rear 3 Angle 99 Unknown

Codes: 0 No collision between two Motor Vehicles in transport 1 Rear End (Front to rear) – An accident where the front of one motor vehicle impacts the rear of

another motor vehicle. Also referred to as front-to-rear. 2 Head-on (Front to front) – An accident where the front ends of two motor vehicles impact together.

This also is referred to as front-to-front. 3 Angle – An accident where two motor vehicles impact at an angle. For example, the front of one

motor vehicle impacts the side of another motor vehicle. Includes front-to-side, same direction, opposite direction, right angle and direction not specified.

4 Sideswipe, same direction – Accidents where two motor vehicles are traveling the same direction and impact on the side.

5 Sideswipe, opposite direction – Accidents where two motor vehicles are traveling in the opposite direction and impact on the side.

6 Rear-to-rear – An accident where the backs of two motor vehicles impact together. 99 Unknown

44

Location of First Harmful Event (B)

Location of First Harmful Event 1 On roadway 6 Separator 2 Shoulder 7 In parking lane or zone 3 Median 8 Off roadway, location unknown 4 Roadside 9 Outside ROW 5 Gore 99 Unknown

The location of first harmful event is used to identity the place, within or outside the trafficway, the accident occurred. Enter the code which best describes the location of the FIRST INJURY OR DAMAGE CAUSING event. The final resting place of the vehicle(s) is NOT a determining factor.(See Appendix D showing diagram defining the sections of the trafficway).

Codes: 1 On Roadway – Review code 7 “In Parking Lane or Zone” before entering this code if the accident

location is in a city or town. 2 Shoulder – In most cases, bridge railings are considered to be located in the shoulder area of the

trafficway. 3 Median – A median is an area of a trafficway between parallel roads separating travel in opposite

directions. A median should be four or more feet wide. Examples: A depressed grassy median separating directions of travel of a divided highway. A median with a concrete traffic barrier, guardrail or other physical barrier, separating roads of a multi-lane divided highway. A flush, painted median of four or more feet of a divided highway.

4 Roadside 5 Gore 6 Separator – A separator is the area of a trafficway between parallel roads separating travel in the

same direction or separating a frontage road from other roads. Example: A depressed grassy or a concrete separator of a freeway between the main travel lanes and a frontage road.

7 In Parking Lane or Zone – This code should be used in the special situation that occurs when the FIRST INJURY OR DAMAGE CAUSING event occurs in an area of a city street normally used for parking. The following areas are considered parking lanes or zones. A. All marked parking stalls, designed for either parallel or diagonal parking, and with or without

parking meters, such as in business districts.B. Those areas of residential streets normally available for parking WHEN THERE ARE PARKED

CARS. When there are no cars parked on a residential street, this code is not appropriate.C. Areas designated for parking at certain times of the day by signing. When parking is allowed by

signing only during certain hours of the day, parking lanes or zones should be considered toexist ONLY during those hours indicated by the signing. At other times, parking lanes or zonesdo not exist and this code is not appropriate.

Note – Shoulders of interstate highways and other rural trafficways are NOT considered parking lanes or zones.

When use of this code is appropriate, it takes precedence over code 1 – “On roadway”. The following rules apply to special situations involving parking lanes or zones. A. If a vehicle traveling on the roadway hits a vehicle in the parking lane or zone, this code should

be used if the vehicle traveling on the roadway has at least one (1) wheel in the parking zone. Ifa vehicle traveling on the roadway hits a vehicle in the parking lane or zone and does not haveany wheels in the parking zone (e.g. hits an open door), this code is NOT appropriate. In thatcase code 1 – “On roadway” should be used.

45

B. If a vehicle exiting a parking lane or zone collides with a vehicle traveling on the roadway, useof this code is NOT appropriate. In that case code 1 – “On roadway” should be used.

8 Off Roadway, Location Unknown 9 Outside right-of-way (trafficway) 99 Unknown

Roadway Surface Condition (C)

Roadway Surface Condition 1 Dry 7 Water (standing,

2 Wet 8 Sand, mud, dirt, gravel 3 Snow 9 Oil 4 Slush 97 Other* 5 Ice 99 Unknown 6 Frost

Enter the code which best describes the condition of the roadway at the accident scene. This element should be coded WITHOUT regard to whether or not road surface conditions contributed to causing the accident.

Codes: 1 Dry 2 Wet 3 Snow 4 Slush 5 Ice 6 Frost 7 Water (standing, moving) 8 Sand, mud, dirt, gravel 9 Oil 97 Other 99 Unknown

Relation to Junction (D)

Relation to Junction 0 Non-junction 7 Alley intersection related 1 Four-way intersection 8 Interchange

14 Crossover related

2 T - intersection 9 Driveway access 15 Bike path or trail 3 Y - intersection 10 Driveway access related 16 Bike path or trail related 4 Five-point, or more 11 Railway crossing 97 Other* 5 Intersection related 12 Railway crossing related 99 Unknown 6 Alley intersection 13 Crossover

Enter the code for this data element which BEST reflects the relation to a junction of the FIRST injury or damage causing event in the accident. THE FINAL RESTING PLACE OF THE UNITS IS NOT A DETERMINING FACTOR.

Codes: 0 Non-junction – This code should be used when an accident does not occur within the

boundaries of any kind of junction and is not related to any type of junction. Review the other available codes before entering this code.

1 Four-way intersection – This code should be used when the FIRST injury or damage causing event in the accident is within the boundaries of a Four-way intersection (See Figure 1). A Four-way intersection is where two roadways cross or connect.

46

2 T- intersection – This code should be used when the FIRST injury or damage causing event in the accident is within the boundaries of a T-intersection (See Figure 1). A T-intersection where two roadways connect and one roadway does not continue across the other roadway. The roadways form a "T”.

3 Y- intersection – This code should be used when the FIRST injury or damage causing event in the accident is within the boundaries of a Y-intersection (See Figure 1). A Y-intersection is where three roadways connect and none of the roadways continue across the other roadways. The roadways form a "Y".

4 Five-point, or more – This code should be used when the FIRST injury or damage causing event in the accident is within the boundaries of a Five-point or more intersection (See Figure 1). A Five-point, or more intersection is where more than two roadways cross or connect.

Figure 1 Examples of Intersections

Intersection Definition: An area which (1) contains a crossing or connection of two or more roadways not classified as driveway access and (2) is an area enclosed by the extension of the curb lines or, if none, the boundaries of the roadways. Where the distance along a roadway between two areas meeting these criteria is less than 33 feet (10 meters), the two areas and the roadway connecting them shall be considered to be parts of a SINGLE intersection.

5 Intersection related – Use this code when the FIRST injury or damage causing event of the accident meets all of the following criteria: (1) occurs on an approach to or exit from any type of an intersection, and (2) results from an activity, behavior, or control related to the movement of traffic units through the intersection, and (3) does not occur within the actual boundaries of the intersection.

Less Than 10 Meters (33 Feet)

Shoulder

Inters

ection

Shoulder Sidewalk

Crosswalk

Curb

10 Meters (33 Feet) or More

Shoulder

Intersection

Curb

Roadway

Sidewalk

Curb

47

The three examples and diagrams below will help to clarify use of this code.

STOP

STOP

STOP

STOP

Included: Intersection Related

Excluded: Intersection

Excluded: Non-Junction

A motor vehicle stopped at a stop sign is rear-ended

A motor vehicle in an intersection waiting to make a left turn is rear-ended

A motor vehicle left roadway when driver fell asleep and hit an approach of a county road

6 Alley intersection – This code should be used when the FIRST injury or damage causing event in the accident is within the boundaries of the intersection of a street and alley.

7 Alley intersection related – Review the definition for code 5 – “Intersection related” and substitute the words “alley intersection” for “intersection”.

48

8 Interchange area – Use this code when the FIRST injury or damage causing event in the accident occurs in an interchange area. An interchange area is defined as follows:

A system of interconnecting roadways in conjunction with one or more grade separations, providing movement of traffic between two or more roadways on different levels.

NOTE: In South Dakota interchanges are located primarily on the Interstate system with a few exceptions on other state trunk highways.

The diagram of an interchange area in Figure 2 will help to clarify the definition.

Figure 2 Interchange Area

30 Meters(100 Feet)

GORE

GORE

GORE

Boundary OfTraffic Way

Ramp

Ramp

Ramp

RampRamp

Roadway

(100 feet)30 Meters

49

9 Driveway access – Note! Driveway access is handled differently than other intersection definitions. Review Figure 3 before deciding how to code this item. Use this code when the FIRST injury or damage causing event in the accident occurs within the boundaries of a driveway access. A driveway access is defined as follows:

A driveway access is a roadway providing access to property adjacent to a trafficway. Only portions of the driveway within the trafficway are included. Included is the portion of home, business, and gas station entrances that is within the trafficway. Entrances and exits to most rest areas are also included. Figure 3 below will help to clarify the definition of a driveway access.

Figure 3

Driveway Access

10 Driveway access related – Use this code when the FIRST injury or damage causing event in the accident occurs near a driveway access and meets all of the following criteria: (1) occurs on a road or street (other than the driveway) on an approach to or exit from a driveway access, and (2) results from an activity, behavior, or control related to the movement of traffic units into or out of a driveway access, and (3) does not occur within the actual boundaries of the driveway access.

11 Railway crossing – Use this code when the First injury or damage causing event in the accident occurs within the boundaries of the intersection of the roadway and rail grade

50

crossing. This would include the collision of one motor vehicle with another motor vehicle while in the boundaries of the intersection or the collision of one motor vehicle with a railway vehicle.

12 Railway crossing related –Review the definition for code 5 – “Intersection related” and substitute the words “Railway crossing” for “intersection”.

13 Crossover – Note! Crossover is handled differently than other intersection definitions. Review the figure below before deciding how to code this item. Use this code when the First injury or damage causing event in the accident occurs within the boundaries of a crossover. A crossover is defined as follows:

An approach located in a median designated for crossing over from one roadway to another. A crossover can ONLY exist when a trafficway has separate roadways and a median. A crossover may or may not be designed for normal vehicular traffic. Interstate crossovers, for example, are closed to traffic except emergency and maintenance vehicles. Crossovers on non-interstate divided trafficways may be designed to allow access to homes or businesses and open to traffic.

14 Crossover related – Use this code when the FIRST injury or damage causing event in the accident occurs near a crossover and meets all of the following criteria: (1) occurs on a road or street (other than the crossover) on an approach to or exit from a crossover, and (2) results from an activity, behavior, or control related to the movement of traffic units into or out of a crossover, and (3) does not occur within the actual boundaries of the crossover.

EXCEPTION: Intersection type codes have priority when the crossover is part of an intersection. The two examples and diagrams below will help to clarify use of this code.

Included: Excluded: Crossover Intersection

Median

Median

15 Bike path or trail – This code should be used when the FIRST injury or damage causing event in the accident is within the boundaries of the intersection of a road or street and bike path or trail.

16 Bike path or trail related – Review the definition for code 5 – “Intersection related” and substitute the words “Bike path or trail” for “intersection”.

97 Other 99 Unknown

51

Light Condition (E)

Light Condition 1 Daylight 5 Dawn 2 Dark - roadway not lighted 6 Dusk 3 Dark - lighted roadway 99 Unknown 4 Dark - unknown roadway lighting

Enter the code which best describes the light conditions at the time of the accident. This element should be coded WITHOUT regard to whether or not light conditions contributed to causing the accident. Codes: 1 Daylight 2 Dark - roadway not lighted – Not lighted refers to the absence of street or highway lighting. 3 Dark – lighted roadway – Lighted refers to the presence of street or highway lights. Lighted

areas will generally include streets within cities or towns and some interchange areas. 4 Dark - unknown roadway lighting – Refers to an inability to determine whether or not the

accident location was illuminated. This code should only be used when an accident is not investigated at the scene and then, only when lighting cannot be determined.

5 Dawn 6 Dusk 99 Unknown

Weather Conditions (F)

Weather Conditions 1 Clear 7 Blowing sand, soil, dirt 2 Cloudy 8 Blowing snow 3 Rain 9 Severe crosswinds 4 Sleet, hail (freezing rain or

97 Other*

5 Snow 99 Unknown 6 Fog, smog, smoke

Enter the code(s) which best describes the weather conditions at the scene of the accident at the time of the accident. Up to two codes can be used to describe the weather conditions. If only one code is used per unit leave the second box “blank” or place a “-“ in the box. This element should be coded WITHOUT regard to whether or not weather conditions contributed to the cause of the accident. Codes: 1 Clear 2 Cloudy 3 Rain 4 Sleet, hail (freezing rain or drizzle) 5 Snow 6 Fog, smog, smoke 7 Blowing sand, soil, dirt 8 Blowing snow 9 Severe crosswind 97 Other 99 Unknown

52

Non-Motorist Action (G)

Non-Motorist Action 1 Entering or crossing specified location 6 Working 2 Walking, running, jogging, playing, cycling, skating 7 Standing 3 Playing or working on motor vehicle 8 Laying 4 Pushing motor vehicle 97 Other* 5 Approaching or leaving motor vehicle 99 Unknown

Enter the code that describes the non-motorist’s (pedestrian or pedalcycle operator) action prior to the accident. The coding box should be crossed out with an “X” when the unit is not a non-motorist. Codes: 1 Entering or crossing specified location 2 Walking, running, jogging, playing, cycling, skating 3 Playing or working on motor vehicle 4 Pushing motor vehicle 5 Approaching or leaving motor vehicle 6 Working 7 Standing 8 Laying 97 Other 99 Unknown

Non-Motorist Contributing Circumstances (H)

Non-Motorist Contributing Circumstances 0 None 6 Distracted 1 Improper crossing 7 Failure to obey traffic signs, signals, or officer 2 Darting 8 Wrong side of road 3 Laying and/or illegally in roadway 97 Other* 4 Failure to yield right of way 99 Unknown 5 Not visible (dark clothing)

Enter the code(s) that best describes the non-motorist (pedestrian or pedalcycle operator) contributing circumstances, which contributed to the accident. Up to two codes can be used to describe the non-motorist contributing circumstances. If there are less than 2, place a “0“ in the unused box. Start with the top box. The coding box should be crossed out with an “X” when the unit is not a non-motorist. Codes: 0 None 1 Improper crossing 2 Darting 3 Laying and/or illegally in roadway 4 Failure to yield right of way 5 Not visible (dark clothing) 6 Distracted 7 Failure to obey traffic signs, signals, or officer 8 Wrong side of road 97 Other 99 Unknown

53

Non-Motorist Location (I)

Non-Motorist Location 1 Marked crosswalk at intersection 7 Island 13 In building 2 At intersection but no crosswalk 8 Shoulder 97 Other* 3 Non-intersection crosswalk 9 Sidewalk 99 Unknown 4 Driveway access crosswalk 10 Roadside 5 In roadway (not in crosswalk or intersection) 11 Outside trafficway 6 Median (but not on shoulder) 12 Shared-use path or trails

Enter the code that best describes the non-motorist’s (pedestrian or pedalcycle operator) location at the time of impact. The coding box should be crossed out with an “X” when the unit is not a non-motorist. Codes: 1 Marked crosswalk at intersection 2 At intersection but no crosswalk 3 Non-intersection crosswalk 4 Driveway access crosswalk 5 In roadway (not in crosswalk or intersection) 6 Median (but not on shoulder) 7 Island 8 Shoulder 9 Sidewalk 10 Roadside 11 Outside trafficway 12 Shared-use path or trails 13 In building 97 Other 99 Unknown

Roadway Alignment/Grade (J)

Roadway Alignment/Grade 1 Straight and level 5 Curve and hill crest 2 Straight and hill crest 6 Curve on grade 3 Straight on grade 99 Unknown 4 Curve and level

Enter the code that best describes the roadway in terms of alignment and grade.

Codes: 1 Straight and level 2 Straight and hill crest 3 Straight on grade 4 Curve and level 5 Curve and hill crest 6 Curve on grade 99 Unknown

54

Roadway Surface Type (K)

Roadway Surface Type 1 Concrete 2 Asphalt (Blacktop) 3 Gravel 4 Dir

5 Brick or Block 97 Other* 99 Unknown

Enter the code which best describes the type of surface of the roadway at the scene of the accident. This element should be coded WITHOUT regard to whether or not roadway surface type contributed to causing the accident. Codes: 1 Concrete 2 Asphalt (Blacktop) 3 Gravel 4 Dirt 5 Brick or Block 97 Other* 99 Unknown

Trafficway Description (L) Enter the code to indicate whether or not a trafficway is divided and whether it serves one-way or two-way traffic. (A divided trafficway is one on which roadways for travel in opposite directions is physically separated by a median.) When an accident occurs within the confines of an intersection assign the “trafficway description” of the highest highway system or the one that appears to carry the heaviest volume of traffic. Codes: 1 Two-way, not divided 2 Two-way, not divided with a continuous left turn lane 3 Two-way, divided, unprotected (painted >4 feet) median 4 Two-way, divided, positive median barrier 5 One-way trafficway 99 Unknown

55

Investigator’s Property Damage only Wild Animal Accident Form (Short Form) The Investigator’s Motor Vehicle Accident Report may also be used as a Wild Animal Accident Form “Short Form”. The Short Form is available for reporting single vehicle accidents involving wildlife (deer, antelope, fox, etc.) in which only damage sustained was to the vehicle. If the damage is $1,000 or greater this report should be used. If the accident involved wildlife other than a deer please note in the narrative the type of wildlife involved. To use the report as a Short Form, complete all gray shaded areas. The non-shaded areas on the form do not need to be completed.

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Example Reports

Example #1: Single Motor Vehicle with Driver on a Rural US highway Reference: MRM (Milepost) – Accident location is less than 1/10 of a mile from an MRM.

Agency Use

1

V

eh C

onfig

urat

ion

Please Type or Print Sheet 1 of 1

Trav

el D

irect

ion

Bef

ore

Acc

iden

t

13 1

1 LO

CA

TIO

N

Date of Accident (MM/DD/YY) 7/24/02

Time of Accident (HHMM) 2004

County Lawrence

City Accident Occurred in or Indicate Rural Rural

1

2 2

Road, Street or Highway Accident Occurred

US 85 At its Intersection With

2

____50___ Miles & Tenths Feet N S E W

Of MRM (Milepost) 30.00

2

14

1

0

Trai

ler T

ype

NOTE: Unless accident occurred within an intersection completely described above, use space below to give the location from a junction or intersecting street. 1

4

Driv

er C

ontri

b C

ircum

stan

ces (1st) _________ Miles & Tenths Feet

N S E W

Junction }

2 1

20 (2nd) _________ Miles & Tenths Feet Of

Intersecting Street

Full Name (Last, First, Middle) Smith, Joe A.

Address Box 123

City Deadwood

State SD

Zip 57732

2

3

C

argo

Bod

y Ty

pe Date of Birth

8-18-62 Phone No

605-555-1234 Driver’s License Number

00123456 Citation Charge? Yes No Pending Unknown 1 2

1. 2.

2 DL State SD

DL Class 1

DL Status: Normal, within restrictions No license required

Violation: Beyond restrictions Under suspension


Unknown

Veh

icle

Con

trib

Circ

umst

ance

s

4

Initi

al P

oint

of I

mpa

ct Owner’s Name (Last, First, Middle) Check if Same as Driver Address City State Zip

15 1

12 VIN #

12888B540Z4563 Insurance Co Name

State Farm Insurance Policy #

12345678-9 Eff Date

1/02 Exp Date

1/03 1

0 2

T 1

Model Yr 1999

Make Chevrolet

Model Corvette

License Plate # 17C 1234

State Wy

Year 2002

Damage Amount Veh and Contents $ 10,000

2

5

Mos

t Dam

aged

Are

a UN

I Total Occupants 1

Speed Limit 55

Est Travel Speed ____75_____




No Estimate

Veh

icle

Man

euve

r

1

13 Hit and Run?

Yes No Unknown Damage Extent: None - No Damage

Minor Damage Functional Damage Disabling Damage


Emergency Vehicle Use? Yes No Unknown 16

2 Trailer License Plate # Attached to Power Unit: __________X____________

State Year Trailer License Plate # Attached to Trailer Unit: __________X_____________

State Year 1

1

6

Und

errid

e/O

verr

ide You must

Complete boxed area

IF the accident involved one or more of the following: • a truck having a GCWR of 10,001 or more pounds; OR • a vehicle displaying a hazardous material placard; OR • a vehicle designed to transport 9 or more people, including driver

AND, the accident resulted in one or more of the following: • a fatality; OR • an injury requiring transportation for immediate medical attention; OR • a vehicle was disabled requiring a towaway from the scene

2

1

0

Traf

fic C

ontro

l Dev

ice

Type

2 Accident involved vehicle - Purpose? Commercial Interstate Commercial Intrastate Government Personal Carrier Name

Address City State Zip 17

7

US DOT #

GVWR GCWR Placard # or Name

Hazardous Material Released? Yes No Unknown

1

0 1

1

Alc

ohol

Use

UN

IT 2

Full Name (Last, First, Middle) Address City State Zip 2

2 Date of Birth Phone No Driver’s License Number Citation Charge? Yes No Pending Unknown

Vis

ion

Con

trib

Circ

umst

ance

s

18 1. 2.

8

DL State DL Class DL Status: Normal, within restrictions No license required

Violation: Beyond restriction Under suspension


Unknown

1

0 1

09

Alc

ohol

Tes

t Owner’s Name (Last, First, Middle) Check if Same as Driver Address City State Zip 2

2 VIN # Insurance Co Name Insurance Policy # Eff Date Exp Date

9

Model Yr Make Model License Plate #


Roa

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19 1

0

Dru

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se

Total Occupants

Speed Limit





No Estimate 1

11 2 Hit and Run?





2



State Year

10

Dru

g Te

st

You must complete boxed area for Unit 2, if the criteria is met shown above in Unit 1 1

2 Accident Involved Vehicle - Purpose? Commercial Interstate Commercial Intrastate Government Personal

2 Carrier Name


11

Zo

ne US DOT #


Hazardous Material Released?

Yes No Unknown

96



School Bus Related?



Acc

iden

t Num

ber –

Offi

ce U

se O

nly

_23__ _____ First Event Object(s) Damaged (Property other than vehicles and contents) Guardrail

_44__ _____ Second Event 12

Wor

k Zo

ne L

ocat

ion

96 Owner’s Name (Last, First, Middle) South Dakota Department of Transportation

Estimate of Damage $ 200 _57__ _____ Third Event

__7__ _____ Fourth Event Address 700 E Broadway Ave

City Pierre

State SD

Zip 57501

__7__ _____ Most Harmful Event by Vehicle (use codes 0, 7-66 only)

Form DPS-AR1 02-28-13 Mail to : Office of Accident Records, 118 W. Capitol Ave, Pierre, SD 57501

_23__ First Harmful Event of Accident (use codes 7-66 only)

58

Seating Position

Uni

t No.

Uni

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Sex

Seat

ing

Posi

tion

Inju

ry S

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Ejec

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Sour

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Operator 1 2 3

4 5 6

7 8 9

10 11 12

UNIT 1 Transported to: EMS Trip # 1 1 1 3 0 0 0 0


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ner o

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PER

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S IN

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Non

-Mot

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Address: Transported to: EMS Trip # 1

X A 2. Name: Date of Birth

0 2



Non

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H Address: Transported to: EMS Trip # 1

X

Loca

tion

of F

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arm

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4. Name: Date of Birth 1

X B


1

DIA

GR

AM

ACCIDENT DIAGRAM 2

Indicate North

1

US 85

Rolling down cliff

Col

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n w

ith E

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Col

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ith G

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rail

Col

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Non

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NARRATIVE: Describe What Happened

F Unit 1 was traveling South on US85 negotiating a left curve when a deer entered the highway. The driver tried to avoid the deer but was unable to and

Traf

ficw

ay D

escr

iptio

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1 collided with the deer losing control of the vehicle, crashing through a guardrail, hitting an embankment and rolling twice down a cliff, and coming to rest against two trees. Driver statements and the final resting place of the unit indicated the driver had been traveling at a high rate of speed. The L

driver had an odor of alcohol on his breath. He was pinned in the unit but sustained only minor injuries. 1


Officer & ID No Filing Report Sgt. Joe Smith #999

Date Notified 7/24/02

Time Notified 2415

Date Arrived 7/24/02

Time Arrived 2425

Agency Name South Dakota Highway Patrol


Officer Approving Report Bob Green

Date Approved 7/25/02

Red Tag #: Unit 1 ___R123456__

Agency Use


Photos Taken? Yes No Unknown Unit 2 ________________

Printed on recycled paper

Example #2: Three Motor Vehicles with Drivers on a Rural Interstate Highway

Reference: MRM – Accident location is 1/10 of a mile or more from an MRM. Agency Use

1

Veh

Con

figur

atio

n


Trav

el D

irect

ion

Bef

ore

Acc

iden

t

13 1

1

LOC

ATI

ON



County Minnehaha


1

4 2

1 Road, Street or Highway Accident Occurred

I 90 Exit #406 At its Intersection With

SD 11

2

4

____0.6__ Miles & Tenths Feet N S E W

Of MRM (Milepost) 406.00

2

14

1

0

Trai

ler T

ype


0

Driv

er C

ontri

b C

ircum

stan


N S E W

Junction }

2

0 1

0 (2nd) _________ Miles & Tenths Feet

Of Intersecting Street

Full Name (Last, First, Middle) Smith, Joe Adam

Address RR #1

City Salem

State NE

Zip 51234

2

0

3

C

argo

Bod

y Ty

pe Date of Birth

02/14/54 Phone No



0 1. 2.

2 DL State NE

DL Class 1




Unknown

Veh

icle

Con

trib

Circ

umst

ance

s

4

Initi

al P

oint

of I

mpa


15 1

6 VIN #



12345678-9 Eff Date

1/02 Exp Date

1/03 1

0 2

6

T 1

Model Yr 1998

Make Chevrolet

Model Impala

License Plate # 55 256B

State NB

Year 2002


2

0

5

Mos

t Dam

aged

Are

a UN

I Total Occupants 1

Speed Limit 55





No Estimate

Veh

icle

Man

euve

r

1

6 Hit and Run?





2

6 Trailer License Plate # Attached to Power Unit: __________X____________


State Year 1

11

6

Und

errid

e/O

verr

ide

You must Complete boxed area



2

11 1

0

Traf

fic C

ontro

l Dev

ice

Type

2



7

US DOT #



1

5 1

0

Alc

ohol

Use

UN

IT 2

Full Name (Last, First, Middle) Paul, John Norman

Address Washington St

City Brandon

State SD

Zip 51234

2

5 2

0 Date of Birth

4/2/77 Phone No


00123456 Citation Charge? Yes No Pending Unknown

Vis

ion

Con

trib

Circ

umst

ance

s

18 1. 2.

8

DL State SD

DL Class 1




Unknown

1

0 1

91

Alc

ohol

Tes


0 2

91 VIN #

1234D125N12V Insurance Co Name

Liberty Mutual Insurance Policy #

AT1230015032151 Eff Date

6/02 Exp Date

7/03

9

Model Yr 2001

Make Toyota

Model Camery

License Plate # 1AB 123

State SD

Year 2002

Damage Amount Veh and Contents $ 2,500.00

Roa

d C

ontri

b C

ircum

stan

ces

19 1

0

Dru

g U

se

Total Occupants 4

Speed Limit 55

Est Travel Speed ___0_____




No Estimate 1

0 2

0 Hit and Run?





2

0

Trailer License Plate # Attached to Power Unit: _________X_____________


State Year

10

Dru

g Te

st



2

2 Carrier

Name Address City State Zip

11

Zo

ne US DOT #



Yes No Unknown

96



School Bus Related?



Acc

iden

t Num

ber –

Offi

ce U

se O

nly

_25__ _25__ First Event Object(s) Damaged (Property other than vehicles and contents)

_____ _____ Second Event 12

Wor

k Zo

ne L

ocat

ion

96 Owner’s Name (Last, First, Middle)

Estimate of Damage $ _____ _____ Third Event

_____ _____ Fourth Event Address

City

State

Zip

_25__ _25__ Most Harmful Event by Vehicle (use codes 0, 7-66 only)



60

Seating Position

Uni

t No.

Uni

t Typ

e

Sex

Seat

ing

Posi

tion

Inju

ry S

tatu

s

Ejec

tion

Sour

ce o

f Tra

nspo

rt

Air B

ag D

eplo

yed

Safe

ty E

quip

men

t



Operator 1 2 3

4 5 6

7 8 9

10 11 12


UNIT 2 Transported to: Sioux Falls Hospital

EMS Trip # 123456 1 1 1 2 0 1 0 1

Man

ner o

f Col

lisio

n

PER

SON

S IN

JUR

IED

1. Name:Smith, Jane Ann

Date of Birth 3/23/55 2 2 3 2 0 1 0 1

Non

-Mot

oris

t Act

ion

G Address: 115 UNKNOWN ST, BRANDON, SD 57005 Transported to:

Sioux Falls Hospital EMS Trip #

123456 1


1 2

X Address: Transported to: EMS Trip #


Non

-Mot

oris

t Con

trib.

Circ

umst

ance


X

Loca

tion

of F

irst H

arm

ful E

vent


X B Address: Transported to: EMS Trip #

1

DIA

GR

AM

ACCIDENT DIAGRAM 2

X

SD 1

1

I90 WBL

I90 EBL

I90 Exit #406Indicate North

Not Involved

12

3

Yie

ld

2

X

Non

-Mot

oris

t Loc

atio

n I

Roa

dway

Sur

face

Con

ditio

n

C

1

X

1 2

X

D

Rel

atio

n to

Jun

ctio

n

Roa

dway

Alig

nmen

t/Gra

de

J

8 3

E

Ligh

t Con

ditio

n

K

Roa

dway

Sur

face

Typ

e

6 2

Wea

ther

Con

ditio

ns

NAR

RAT

IVE


F Unit #1 slowed and stopped at yield sign for westbound traffic on I90. Unit #2 stopped behind unit #1. Unit #3 was following too closely and was

Traf

ficw

ay D

escr

iptio

n

1 traveling too fast for conditions to prevent him from stopping soon enough to avoid a collision. Unit #3 rear-ended unit #2 causing unit #2 to rear-end unit #1. The driver of unit #3 stated he took his eyes off the road momentarily to look for L

traffic on I90. Unit #3 was equipped with badly worn tires. 3


Officer & ID No Filing Report Sgt. Joe Smith #999


Time Notified 0938


Time Arrived 0945

Agency Name South Dakota Highway Patrol




Red Tag #: Unit 1 ___R1235546____

Agency Use


Photos Taken? Yes No Unknown Unit 2 ___R2451545___


61

Example #2: Continued Agency Use

1

Veh

Con

figur

atio

n


Trav

el D

irect

ion

Bef

ore

Acc

iden

t

13 1

15 LO

CA

TIO

N



County Minnehaha


1

4 2

Road, Street or Highway Accident Occurred

I90 Exit #406 At its Intersection With

SD11

2

________ Miles & Tenths Feet N S E W

Of MRM (Milepost)

2

14

1

0

Trai

ler T

ype


14

Driv

er C

ontri

b C

ircum

stan


N S E W

Junction }

2 1

5 (2nd) _________ Miles & Tenths Feet


Full Name (Last, First, Middle) Smith, William Bob

Address Box 123

City Sioux Falls

State SD

Zip 57123

2

3

C

argo

Bod

y Ty

pe Date of Birth

8-18-62 Phone No



1. Following too closely 2.

2 DL State SD

DL Class 1




Unknown

Veh

icle

Con

trib

Circ

umst

ance

s

4

Initi

al P

oint

of I

mpa


15 1

12 VIN #



12345678-9 Eff Date

1/02 Exp Date

1/03 1

5 2

T 1

3

Model Yr 1990

Make Ford

Model F250

License Plate # 17C 1234

State SD

Year 2002

Damage Amount Veh and Contents $ 800.00

2

5

Mos

t Dam

aged

Are

a UN

I Total Occupants 1

Speed Limit 55





No Estimate

Veh

icle

Man

euve

r

1

12 Hit and Run?





2 Trailer License Plate # Attached to Power Unit: _________X_____________


State Year 1

1

6

Und

errid

e/O

verr

ide You must

Complete boxed area



2

1

0

Traf

fic C

ontro

l Dev

ice

Type



7

US DOT #



1

5 1

0

Alc

ohol

Use

UN

IT 2

Full Name (Last, First, Middle) Address City State Zip 2

2 Date of Birth Phone No Driver’s License Number Citation Charge? Yes No Pending Unknown

Vis

ion

Con

trib

Circ

umst

ance

s

18 1. 2.

8

DL State DL Class DL Status: Normal, within restrictions No license required



Unknown

1

0 1

91

Alc

ohol

Tes


2 VIN # Insurance Co Name Insurance Policy # Eff Date Exp Date

9

Model Yr Make Model License Plate #


Roa

d C

ontri

b C

ircum

stan

ces

19 1

0

Dru

g U

se

Total Occupants

Speed Limit





No Estimate 1

0 2 Hit and Run?





2



State Year

10

Dru

g Te

st



2 Carrier Name


11

Zo

ne US DOT #



Yes No Unknown

96



School Bus Related?



Acc

iden

t Num

ber –

Offi

ce U

se O

nly

_25__ _____ First Event Object(s) Damaged (Property other than vehicles and contents)


Wor

k Zo

ne L

ocat

ion




City

State

Zip

__25_ _____ Most Harmful Event by Vehicle (use codes 0, 7-66 only)



62

Seating Position

Uni

t No.

Uni

t Typ

e

Sex

Seat

ing

Posi

tion

Inju

ry S

tatu

s

Ejec

tion

Sour

ce o

f Tra

nspo

rt

Air B

ag D

eplo

yed

Safe

ty E

quip

men

t



Operator 1 2 3

4 5 6

7 8 9

10 11 12



Man

ner o

f Col

lisio

n

PER

SON

S IN

JUR

IED


Non

-Mot

oris

t Act

ion G


X A 2. Name: Date of Birth 2



Non

-Mot

oris

t Con

trib.

Circ

umst

ance


X

Loca

tion

of F

irst H

arm

ful E

vent



DIA

GR

AM

ACCIDENT DIAGRAM 2

Indicate North 2

Non

-Mot

oris

t Loc

atio

n I

Roa

dway

Sur

face

Con

ditio

n

C

1

X 2

D

Rel

atio

n to

Jun

ctio

n

Roa

dway

Alig

nmen

t/Gra

de

J

E

Ligh

t Con

ditio

n

K

Roa

dway

Sur

face

Typ

e

Wea

ther

Con

ditio

ns

NAR

RAT

IVE


F

Traf

ficw

ay D

escr

iptio

n

L


Officer & ID No Filing Report Date Notified Time Notified Date Arrived Time Arrived

Agency Name Agency Type Highway Patrol Sheriff Department City Police BIA Tribal Police Other

Officer Approving Report

Date Approved Red Tag #: Unit 1 ___1234568__

Agency Use


Photos Taken? Yes No Unknown Unit 2 _________________


63

Example #3: Hit and Run on a Rural County Road

Reference: from a Junction Agency Use

1

Veh

Con

figur

atio

n


Trav

el D

irect

ion

Bef

ore

Acc

iden

t

13 1

1

LOC

ATI

ON



County Lincoln


1

2 2


County Road 116 At its Intersection With

County Road 111

2

3

_______ Miles & Tenths Feet N S E W

Of MRM (Milepost)

2

14

1

0

Trai

ler T

ype


3

Driv

er C

ontri

b C

ircum

stan

ces (1st) ___2.0____ Miles & Tenths Feet

N S E W

Junction } SD 17 & County Road 110 2

0 1

6 (2nd) __3.0____ Miles & Tenths Feet


Full Name (Last, First, Middle) Unknown (Hit & Run)

Address

City

State

Zip

2

0

3

C

argo

Bod

y Ty

pe Date of Birth

Phone No


Citation Charge? Yes No Pending Unknown 1 2

0 1. 2.

2 DL State

DL Class




Unknown

Veh

icle

Con

trib

Circ

umst

ance

s

4

Initi

al P

oint

of I

mpa


15 1

11 VIN #

Insurance Co Name

Insurance Policy #

Eff Date

Exp Date

1

99 2

7

T 1

Model Yr

Make

Model

License Plate #

State

Year

Damage Amount Veh and Contents $

2

0

5

Mos

t Dam

aged

Are

a UN

I Total Occupants

Speed Limit





No Estimate

Veh

icle

Man

euve

r

1

11 Hit and Run?





2

7 Trailer License Plate # Attached to Power Unit: _______________________


State Year 1

5

6

Und

errid

e/O

verr

ide




2

1 1

0

Traf

fic C

ontro

l Dev

ice

Type

2



7

US DOT #



1

4 1

99

Alc

ohol

Use

UN

IT 2

Full Name (Last, First, Middle) Gilbert, Alvin James

Address Box 123

City Lennox

State SD

Zip 51234

2

0 2

0 Date of Birth

10/24/79 Phone No



Vis

ion

Con

trib

Circ

umst

ance

s

18 1. 2.

8

DL State SD

DL Class 1




Unknown

1

0 1

99

Alc

ohol

Tes


0 2

91 VIN #



AT1230015032151 Eff Date

6/02 Exp Date

7/03

9

Model Yr 1996

Make Ford

Model Mustang


State SD

Year 2002


Roa

d C

ontri

b C

ircum

stan

ces

19 1

99

Dru

g U

se

Total Occupants 1

Speed Limit 55

Est Travel Speed __55____




No Estimate 1

0 2

0 Hit and Run?





2

0

Trailer License Plate # Attached to Power Unit: ________X______________

State Year Trailer License Plate # Attached to Trailer Unit: ________X_______________

State Year

10

Dru

g Te

st



2

2 Carrier


11

Zo

ne US DOT #



Yes No Unknown

96



School Bus Related?



Acc

iden

t Num

ber –

Offi

ce U

se O

nly

_25__ _25__ First Event Object(s) Damaged (Property other than vehicles and contents)


Wor

k Zo

ne L

ocat

ion




City

State

Zip

_25__ _25__ Most Harmful Event by Vehicle (use codes 0, 7-66 only)



64

Seating Position

Uni

t No.

Uni

t Typ

e

Sex

Seat

ing

Posi

tion

Inju

ry S

tatu

s

Ejec

tion

Sour

ce o

f Tra

nspo

rt

Air B

ag D

eplo

yed

Safe

ty E

quip

men

t



Operator 1 2 3

4 5 6

7 8 9

10 11 12



Man

ner o

f Col

lisio

n

PER

SON

S IN

JUR

IED


Non

-Mot

oris

t Act

ion G



3 2



Non

-Mot

oris

t Con

trib.

Circ

umst

ance


X

Loca

tion

of F

irst H

arm

ful E

vent



1

DIA

GR

AM

ACCIDENT DIAGRAM 2

X

Co.

Rd.

111

County Road 116

STOP

Indicate North

1

2

2

X

Non

-Mot

oris

t Loc

atio

n I

Roa

dway

Sur

face

Con

ditio

n

C

1

X

1 2

X

D

Rel

atio

n to

Jun

ctio

n

Roa

dway

Alig

nmen

t/Gra

de

J

1 1

E

Ligh

t Con

ditio

n

K

Roa

dway

Sur

face

Typ

e

1 2

Wea

ther

Con

ditio

ns

NAR

RAT

IVE


F Unit #2 was proceeding East on County Road 116. Unit #1 was southbound on County Road 111 approaching the stop sign at the intersection of

Traf

ficw

ay D

escr

iptio

n

2 116 and 111. The driver of unit #2 stated that unit #1 slowed but did not stop for the stop sign. Unit #1, attempting a right turn onto County Road 116, crossed the centerline of 116 and collided with the left rear of unit #2. Unit #1 continued westbound on 116 without stopping. At this time the driver of L

Unit #1 has not been located. 1


Officer & ID No Filing Report Sheriff Bob Smith #999


Time Notified 1650


Time Arrived 1714

Agency Name Lincoln Sheriff Department



Date Approved 8/14/02 Red Tag #:

Unit 1 _________________

Agency Use


Photos Taken? Yes No Unknown Unit 2 ___R1231541__


65

Example #4: Train/Motor Vehicle on a Rural Township Road

Reference: from a Junction Agency Use

1

Veh

Con

figur

atio

n


Trav

el D

irect

ion

Bef

ore

Acc

iden

t

13 1

1 LO

CA

TIO

N



County Brown


1

2 2

X Road, Street or Highway Accident Occurred

Township Road At its Intersection With

2

X

_________ Miles & Tenths Feet N S E W

Of MRM (Milepost)

2

14

1

0

Trai

ler T

ype


3

Driv

er C

ontri

b C

ircum

stan

ces (1st) ___6.0__ Miles & Tenths Feet

N S E W

Junction } US12 and Co Rd 18 2

X 1

27 (2nd) ___2.0__ Miles & Tenths Feet


Full Name (Last, First, Middle) Doe, John Adam

Address 908 Plum St.

City Aberdeen

State SD

Zip 51234

2

X

3

C

argo

Bod

y Ty

pe Date of Birth

4/10/75 Phone No



X 1. 2.

2 DL State SD

DL Class 1




Unknown

Veh

icle

Con

trib

Circ

umst

ance

s

4

Initi

al P

oint

of I

mpa


15 1

4 VIN #



12345678-9 Eff Date

1/02 Exp Date

1/03 1

0 2

X T 1

Model Yr 1988

Make Chevrolet

Model Impala

License Plate # 3B 123

State SD

Year 2002


2

X

5

Mos

t Dam

aged

Are

a UN

I Total Occupants 1

Speed Limit 55

Est Travel Speed ____45___




No Estimate

Veh

icle

Man

euve

r

1

4 Hit and Run?





2

X Trailer License Plate # Attached to Power Unit: _________X_____________


State Year 1

1

6

Und

errid

e/O

verr

ide




2

X 1

0

Traf

fic C

ontro

l Dev

ice

Type

2

X Accident involved vehicle - Purpose? Commercial Interstate Commercial Intrastate Government Personal Carrier Name


17

7

US DOT #



1

9 1

0

Alc

ohol

Use

UN

IT 2

Full Name (Last, First, Middle) Doe, Jane Marie

Address 800 West St

City Watertown

State SD

Zip 51234

2

X 2

0 Date of Birth

4/2/67 Phone No



Vis

ion

Con

trib

Circ

umst

ance

s

18 1. 2.

8

DL State

DL Class




Unknown

1

5 1

91

Alc

ohol

Tes

t Owner’s Name (Last, First, Middle) Check if Same as Driver Burlington Northern

Address 1000 Main St

City Watertown

State SD

Zip 54321

2

X 2

91 VIN #

Insurance Co Name

Insurance Policy #

Eff Date

Exp Date

9

Model Yr

Make

Model

License Plate #

State

Year


Roa

d C

ontri

b C

ircum

stan

ces

19 1

0

Dru

g U

se

Total Occupants

Speed Limit

Est Travel Speed ________




No Estimate 1

0 2

0 Hit and Run?





2

X



State Year

10

Dru

g Te

st



2

2 Carrier


11

Zo

ne US DOT #



Yes No Unknown

96



School Bus Related?



Acc

iden

t Num

ber –

Offi

ce U

se O

nly

_22__ _X__ First Event Object(s) Damaged (Property other than vehicles and contents)


Wor

k Zo

ne L

ocat

ion




City

State

Zip

_22__ _X__ Most Harmful Event by Vehicle (use codes 0, 7-66 only)



66

Seating Position

Uni

t No.

Uni

t Typ

e

Sex

Seat

ing

Posi

tion

Inju

ry S

tatu

s

Ejec

tion

Sour

ce o

f Tra

nspo

rt

Air B

ag D

eplo

yed

Safe

ty E

quip

men

t



Operator 1 2 3

4 5 6

7 8 9

10 11 12

UNIT 1 Transported to: St Lukes

EMS Trip # 123456 1 1 1 3 0 1 0 3


Man

ner o

f Col

lisio

n

PER

SON

S IN

JUR

IED


Non

-Mot

oris

t Act

ion G



0 2



Non

-Mot

oris

t Con

trib.

Circ

umst

ance


X

Loca

tion

of F

irst H

arm

ful E

vent



1

DIA

GR

AM

ACCIDENT DIAGRAM 2

X 2

X

Non

-Mot

oris

t Loc

atio

n I

Roa

dway

Sur

face

Con

ditio

n

C

1

X

1 2

X

D

Rel

atio

n to

Jun

ctio

n

Roa

dway

Alig

nmen

t/Gra

de

J

11 1

E

Ligh

t Con

ditio

n

K

Roa

dway

Sur

face

Typ

e

1 3

Wea

ther

Con

ditio

ns

NAR

RAT

IVE


F Box #14 – Loudness of radio prevented driver from hearing train whistle.

Traf

ficw

ay D

escr

iptio

n

1 Unit #1 was southbound on a township road approaching a railroad crossing. The driver of unit #1 stated he was traveling at approximately 45 mph. L

A BN train was eastbound approaching the township road. The engineer of the train stated he was traveling at approximately 15 mph and began to 1

sound his whistle 300-350 ft from the crossing. The driver of unit #1 stated he did not see the train because a cornfield was blocking his view and he did not hear the whistle until he was nearly to the crossing. The driver of unit #1 stated he knew he could not stop in time so he increased his speed in an attempt to avoid the collision. The engine of the train struck the right rear portion of unit #1. The train stopped as quickly as possible. Unit #1 came to rest in the East road ditch. This officer noted upon reaching the scene that the radio in unit #1 was on quite loud, the air conditioner was running and the windows were closed, possibly accounting for his failure to hear the whistle sound. There were no injuries to the occupants of the train. The driver of unit #1 sustained injuries which required calling an ambulance to transport him to the hospital.


Officer & ID No Filing Report Sgt John A. Smith #999


Time Notified 1632


Time Arrived 1645

Agency Name Brown County Sheriff




Red Tag #: Unit 1 ___R124578__

Agency Use




67

Example #5: Driverless Motor Vehicle/Parked Motor Vehicle Reference: from the nearest Intersecting Street

Agency Use

1

Veh

Con

figur

atio

n


Trav

el D

irect

ion

Bef

ore

Acc

iden

t

13 1

1 LO

CA

TIO

N



County Hughes

City Accident Occurred in or Indicate Rural Pierre

1

4 2


N. Huron Ave At its Intersection With

2

5


Of MRM (Milepost)

2

14

1

0

Trai

ler T

ype


X

Driv

er C

ontri

b C

ircum

stan

ces (1st) ___75__ Miles & Tenths Feet

N S E W

Junction } W Capitol Ave 2

0 1

X (2nd) _______ Miles & Tenths Feet


Full Name (Last, First, Middle) None (Driverless)

Address

City

State

Zip

2

X

3

C

argo

Bod

y Ty

pe Date of Birth

Phone No



X 1. 2.

2 DL State

DL Class




Unknown

Veh

icle

Con

trib

Circ

umst

ance

s

4

Initi

al P

oint

of I

mpa

ct Owner’s Name (Last, First, Middle) Check if Same as Driver

Doe, John Adam Address

200 Polk St City

Pierre State

SD Zip 57501 15

1

7 VIN #



12345678-9 Eff Date

1/02 Exp Date

1/03 1

0 2

2

T 1

Model Yr 1995

Make Chrysler

Model LHS


State SD

Year 2002


2

X

5

Mos

t Dam

aged

Are

a UN

I Total Occupants 1

Speed Limit 30





No Estimate

Veh

icle

Man

euve

r

1

7 Hit and Run?





2

2 Trailer License Plate # Attached to Power Unit: ________X______________


State Year 1

2

6

Und

errid

e/O

verr

ide




2

15 1

0

Traf

fic C

ontro

l Dev

ice

Type

2



7

US DOT #



1

X 1

X

Alc

ohol

Use

UN

IT 2

Full Name (Last, First, Middle) None (Parked)

Address

City

State

Zip

2

X 2

Date of Birth

Phone No



Vis

ion

Con

trib

Circ

umst

ance

s

18 1. 2.

8

DL State

DL Class




Unknown

1

X 1

X

Alc

ohol

Tes

t Owner’s Name (Last, First, Middle) Check if Same as Driver Smith, John Brown

Address 100 Washington Ave

City Pierre

State SD

Zip 57501

2

X 2

X VIN #

SS23765T7B053

Insurance Co Name State Insurance

Insurance Policy # S1234-45687265

Eff Date 1/02

Exp Date 1/03

9

Model Yr 1995

Make Pontiac

Model Trans Am

License Plate # 36A 456

State SD

Year 2002


Roa

d C

ontri

b C

ircum

stan

ces

19 1

X

Dru

g U

se

Total Occupants 0

Speed Limit





No Estimate 1

X 2

X Hit and Run?





2

X

Trailer License Plate # Attached to Power Unit: ________X______________


State Year

10

Dru

g Te

st


X Accident Involved Vehicle - Purpose? Commercial Interstate Commercial Intrastate Government Personal

2

X Carrier


11

Zo

ne US DOT #



Yes No Unknown

96



School Bus Related?



Acc

iden

t Num

ber –

Offi

ce U

se O

nly

_26__ _ X __ First Event Object(s) Damaged (Property other than vehicles and contents)


Wor

k Zo

ne L

ocat

ion




City

State

Zip

_26__ _ X __ Most Harmful Event by Vehicle (use codes 0, 7-66 only)



68

Seating Position

Uni

t No.

Uni

t Typ

e

Sex

Seat

ing

Posi

tion

Inju

ry S

tatu

s

Ejec

tion

Sour

ce o

f Tra

nspo

rt

Air B

ag D

eplo

yed

Safe

ty E

quip

men

t



Operator 1 2 3

4 5 6

7 8 9

10 11 12

UNIT 1 Transported to: EMS Trip # 3

UNIT 2 Transported to: EMS Trip # 2

Man

ner o

f Col

lisio

n

PER

SON

S IN

JUR

IED

1. Name:Smith, Jame Doe

Date of Birth 1/1/2000 1 1 25 3 0 0 0 0

Non

-Mot

oris

t Act

ion

G Address: 218 Washington Pierre, SD 57501

Transported to: EMS Trip # 1


0 2



Non

-Mot

oris

t Con

trib.

Circ

umst

ance


X

Loca

tion

of F

irst H

arm

ful E

vent



7

DIA

GR

AM

ACCIDENT DIAGRAM 2

X

N.H

uron

Ave

2 1

Public SafetyDriveway

W. Capitol Ave

Parked Vehicle

Parked Veh not involved

Indicate North2

X

Non

-Mot

oris

t Loc

atio

n I

Roa

dway

Sur

face

Con

ditio

n

C

1

X 3

2

X

D

Rel

atio

n to

Jun

ctio

n

Roa

dway

Alig

nmen

t/Gra

de

J

9 1

E

Ligh

t Con

ditio

n

K

Roa

dway

Sur

face

Typ

e

1 2

Wea

ther

Con

ditio

ns

NAR

RAT

IVE


F Unit #1, a driverless motor vehicle, was parked in the driveway of the Public Safety Building. The vehicle was left idling with an unattended 2-year-old

Traf

ficw

ay D

escr

iptio

n

5 child in the front seat. The child put the car in gear, backed across Huron St. and collided with Unit #2, a parked motor vehicle. At this point, Michael Smith, who had left the vehicle unattended, was able to get into the car and stop it. Mr. Smith stated he had been gone only a few minutes L

to conducted business and had left the vehicle idling so it would stay warm. This officer made a check of unit #1 and found the emergency brake 1

had not been engaged. The 2-year-old child received a bruise to his forehead.




Time Notified 1532


Time Arrived 1538

Agency Name Pierre Police Department




Red Tag #: Unit 1 ___R1235486__

Agency Use


Photos Taken? Yes No Unknown Unit 2 ____R3245783__


Example #6: Pedestrian/Motor Vehicle on a City Street Reference: from the nearest Intersecting Street

Agency Use

1

Veh

Con

figur

atio

n


Trav

el D

irect

ion

Bef

ore

Acc

iden

t

13 1

1

LOC

ATI

ON



County Pennington

City Accident Occurred in or Indicate Rural Rapid City

1

2 2

X Road, Street or Highway Accident Occurred

6th Street At its Intersection With

2

X


Of MRM (Milepost)

2

14

1

0

Trai

ler T

ype


2

Driv

er C

ontri

b C

ircum

stan

ces (1st) ___5___ Miles & Tenths Feet

N S E W

Junction } Kansas City Street 2

X 1

24 (2nd) _______ Miles & Tenths Feet


Full Name (Last, First, Middle) Smith, Sara Joe

Address 123 Main St.

City Rapid City

State SD

Zip 57701

2

X

3

C

argo

Bod

y Ty

pe Date of Birth

7/22/65 Phone No



X 1. Failed to yield to pedestrian in crosswalk 2.

2 DL State SD

DL Class 1




Unknown

Veh

icle

Con

trib

Circ

umst

ance

s

4

Initi

al P

oint

of I

mpa

ct Owner’s Name (Last, First, Middle) Check if Same as Driver

Address

City

State

Zip

15 1

1 VIN #



12345678-9 Eff Date

1/02 Exp Date

1/03 1

7 2

X T 1

Model Yr 1994

Make Chevrolet

Model Lumina


State SD

Year 2002

Damage Amount Veh and Contents $ 0

2

X

5

Mos

t Dam

aged

Are

a UN

I Total Occupants 3

Speed Limit 30





No Estimate

Veh

icle

Man

euve

r

1

1 Hit and Run?





2

X Trailer License Plate # Attached to Power Unit: _________X_____________


State Year 1

6

6

Und

errid

e/O

verr

ide




2

X 1

0

Traf

fic C

ontro

l Dev

ice

Type

2



7

US DOT #



1

4 1

0

Alc

ohol

Use

UN

IT 2

Full Name (Last, First, Middle) Johnson, Joe Ray

Address 102 9th Street

City Rapid City

State SD

Zip 57701

2

X 2

1 Date of Birth

5/12/80

Phone No 605-555-4321



Vis

ion

Con

trib

Circ

umst

ance

s

18 1. 2.

8

DL State

DL Class




Unknown

1

0 1

91

Alc

ohol

Tes

t Owner’s Name (Last, First, Middle) Check if Same as Driver

Address

City

State

Zip

2

X 2

91 VIN #

Insurance Co Name

Insurance Policy #

Eff Date

Exp Date

9

Model Yr

Make

Model

License Plate #

State

Year

Damage Amount Veh and Contents $

Roa

d C

ontri

b C

ircum

stan

ces

19 1

0

Dru

g U

se

Total Occupants

Speed Limit





No Estimate 1

8 2

0 Hit and Run?





2

X



State Year

10

Dru

g Te

st



2

2 Carrier


11

Zo

ne US DOT #



Yes No Unknown

96



School Bus Related?



Acc

iden

t Num

ber –

Offi

ce U

se O

nly

_20__ _X __ First Event Object(s) Damaged (Property other than vehicles and contents)


Wor

k Zo

ne L

ocat

ion




City

State

Zip

_20__ _X__ Most Harmful Event by Vehicle (use codes 0, 7-66 only)



70

Seating Position

Uni

t No.

Uni

t Typ

e

Sex

Seat

ing

Posi

tion

Inju

ry S

tatu

s

Ejec

tion

Sour

ce o

f Tra

nspo

rt

Air B

ag D

eplo

yed

Safe

ty E

quip

men

t



Operator 1

2 3

4 5 6

7 8 9

10 11 12


UNIT 2 Transported to:

Rapid City Hospital EMS Trip #

123456 5 1 96 2 96 1 96 0

Man

ner o

f Col

lisio

n

PER

SON

S IN

JUR

IED

1. Name:

Date of Birth

Non

-Mot

oris

t Act

ion G Address: Transported to: EMS Trip # 1

X A 2. Name:

Date of Birth

0 2

1 Address: Transported to: EMS Trip #

3. Name:

Date of Birth

Non

-Mot

oris

t Con

trib.

Circ

umst

ance


X

Loca

tion

of F

irst H

arm

ful E

vent

4. Name:

Date of Birth 1


1

DIA

GR

AM

ACCIDENT DIAGRAM 2

0 Indicate North

STOP

STOP

STO

P

STOP

1

Unit #2 Pedestrian

6th

St.

Kansas City

2

0

Non

-Mot

oris

t Loc

atio

n I

Roa

dway

Sur

face

Con

ditio

n

C

1

X

1 2

1

D

Rel

atio

n to

Jun

ctio

n

Roa

dway

Alig

nmen

t/Gra

de

J

5

1

E

Ligh

t Con

ditio

n

K

Roa

dway

Sur

face

Typ

e

3

2

Wea

ther

Con

ditio

ns

NAR

RAT

IVE


F Unit #2, a pedestrian, was crossing 6th St. in the crosswalk. Unit #1, southbound on 6th St. stopped abruptly blocking the crosswalk. Driver of unit #1

Traf

ficw

ay D

escr

iptio

n

2 stated that she motioned to the pedestrian indicating that he should cross in front of her vehicle. Unit #1 proceeded through the intersection too soon

clipping the pedestrian with the right front fender. The pedestrian suffered injuries to the right hip. The driver of unit #1 proceeded to make a left turn L onto Kansas City St. where she stopped to telephone authorities. This officer determined that the inside right headlight of Unit #1 was not working.

2 Also, due to a possible problem with depth perception, a request was made to have the driver of unit #1 re-examined by a driver license examiner.

A second pedestrian, Robert Barry also of 1020 W. 9th St. stated that he and his roommate had each drank two beers within the last 1-1/2 hour period.




Time Notified 2210

Date Arrived 7/1/02

Time Arrived 2212

Agency Name Rapid City Police Department




Unit 1 ________________

Agency Use




71

Example #7: Pedalcycle Driver/Motor Vehicle on a City Street Reference: from the nearest Intersecting Street

Agency Use

1

Veh

Con

figur

atio

n


Trav

el D

irect

ion

Bef

ore

Acc

iden

t

13 1

X LO

CA

TIO

N



County Minnehaha

City Accident Occurred in or Indicate Rural Sioux Falls

1

1 2


N. Dakota Ave At its Intersection With

2

1


Of MRM (Milepost)

2

14

1

X

Trai

ler T

ype


X

Driv

er C

ontri

b C

ircum

stan

ces (1st) ___125___ Miles & Tenths Feet

N S E W

Junction } 7th Street 2

0 1

X (2nd) _________ Miles & Tenths Feet


Full Name (Last, First, Middle) Smith, Mary Jane

Address 800 Maple Ave

City Sioux Falls

State SD

Zip 51234

2

0

3

C

argo

Bod

y Ty

pe Date of Birth

02/14/74 Phone No



0 1. 2.

2 DL State

DL Class




Unknown

Veh

icle

Con

trib

Circ

umst

ance

s

4

Initi

al P

oint

of I

mpa


15 1

X VIN #

Insurance Co Name

Insurance Policy #

Eff Date

Exp Date

1

X 2

11

T 1

Model Yr

Make

Model

License Plate #

State

Year

Damage Amount Veh and Contents $ 150

2

0

5

Mos

t Dam

aged

Are

a UN

I Total Occupants 1

Speed Limit





No Estimate

Veh

icle

Man

euve

r

1

X Hit and Run?





2

11 Trailer License Plate # Attached to Power Unit: _______________________


State Year 1

X 6

Und

errid

e/O

verr

ide




2

1 1

X

Traf

fic C

ontro

l Dev

ice

Type

2



7

US DOT #



1

X 1

0

Alc

ohol

Use

UN

IT 2

Full Name (Last, First, Middle) Doe, John Norman

Address 323 Washington St

City Sioux Falls

State SD

Zip 51234

2

0

2

0 Date of Birth

4/2/87 Phone No



Vis

ion

Con

trib

Circ

umst

ance

s

18 1. 2.

8

DL State SD

DL Class 1




Unknown

1

X 1

91

Alc

ohol

Tes


7 2

91 VIN #



AT1230015032151 Eff Date

6/02 Exp Date

7/03

9

Model Yr 2001

Make Pontiac

Model Bonneville


State SD

Year 2002


Roa

d C

ontri

b C

ircum

stan

ces

19 1

0

Dru

g U

se

Total Occupants 2

Speed Limit 20

Est Travel Speed ___20_____




No Estimate 1

X 2

0 Hit and Run?





2

8



State Year

10

Dru

g Te

st



2

2 Carrier


11

Zo

ne US DOT #



Yes No Unknown

96



School Bus Related?



Acc

iden

t Num

ber –

Offi

ce U

se O

nly

_X__ _21__ First Event Object(s) Damaged (Property other than vehicles and contents)


Wor

k Zo

ne L

ocat

ion




City

State

Zip

_X __ _21__ Most Harmful Event by Vehicle (use codes 0, 7-66 only)



72

Seating Position

Uni

t No.

Uni

t Typ

e

Sex

Seat

ing

Posi

tion

Inju

ry S

tatu

s

Ejec

tion

Sour

ce o

f Tra

nspo

rt

Air B

ag D

eplo

yed

Safe

ty E

quip

men

t



Operator 1

2 3

4 5 6

7 8 9

10 11 12

UNIT 1 Transported to:

Sioux Valley EMS Trip #

123456 6 2 1 3 96 1 96 0


Man

ner o

f Col

lisio

n

PER

SON

S IN

JUR

IED

1. Name: Smith, Janie

Date of Birth 6/10/02 1 2 18 3 96 1 96 0

Non

-Mot

oris

t Act

ion

G Address:

800 Maple Ave, Sioux Falls, SD Transported to:

Sioux Valley EMS Trip #

123456 1

2 A 2. Name:

Date of Birth

0 2


3. Name:

Date of Birth

Non

-Mot

oris

t Con

trib.

Circ

umst

ance


4

Loca

tion

of F

irst H

arm

ful E

vent

4. Name:

Date of Birth

1

1 B Address: Transported to: EMS Trip #

1

DIA

GR

AM

ACCIDENT DIAGRAM 2

X Indicate North

Unit #1 Bicycle

2

Bicycle Passenger

Bicycle Driver

Parked MV NotInvolved

N. D

akot

a A

ve.

W. 7th St.

Park

ing

Lane

/Zon

e

Park

ing

Lane

/Zon

e

Lane

N -

3

Lane

N -

2

Lane

N -

1

Skid marks 25’

2

X

Non

-Mot

oris

t Loc

atio

n I

Roa

dway

Sur

face

Con

ditio

n

C

1

5

1 2

X

D

Rel

atio

n to

Jun

ctio

n

Roa

dway

Alig

nmen

t/Gra

de

J

0

1

E

Ligh

t Con

ditio

n

K

Roa

dway

Sur

face

Typ

e

1

2

Wea

ther

Con

ditio

ns

NAR

RAT

IVE


F Unit #2 was northbound on N. Dakota Ave. traveling in lane N-1. Unit #1 was stopped in the parking lane. The driver of unit #1 stated she had

Traf

ficw

ay D

escr

iptio

n

2 stopped to attend to her 2 year old daughter who was riding in a child carrier that was attached to the rear of the bicycle. Unit #1 pulled out from the

parking lane into lane N-1 without yielding to unit #2. The driver of unit #2 stated he began braking as soon as he saw the bicycle being ridden out L in front of the parked car, but was unable to stop soon enough to avoid a collision. The left front of unit #2 struck the bicycle throwing both occupants

5 of the bicycle onto the roadway nearby. They sustained what appeared to be minor injuries. The bicycle was totaled. The driver of unit #2 was not

injured. Unit #2 received minor damage to the left front fender. Skid marks indicated that the driver of unit #2 did attempt to stop and was traveling

3-5 mph when impact occurred.




Time Notified 1925


Time Arrived 1929

Agency Name Sioux Falls Police Department




Unit 1 ________________

Agency Use


Photos Taken? Yes No Unknown Unit 2 __R1235468__


73

Overlay Front page of Overlay

74

Back page of Overlay

75

Appendix A State Codes

AL 01 Alabama MT 30 Montana AK 02 Alaska NE 31 Nebraska AZ 04 Arizona NV 32 Nevada AR 05 Arkansas NH 33 New Hampshire CA 06 California NJ 34 New Jersey CO 08 Colorado NM 35 New Mexico CT 09 Connecticut NY 36 New York DE 10 Delaware NC 37 North Carolina DC 11 District of Columbia ND 38 North Dakota FL 12 Florida OH 39 Ohio GA 13 Georgia OK 40 Oklahoma HI 15 Hawaii OR 41 Oregon ID 16 Idaho PA 42 Pennsylvania IL 17 Illinois RI 44 Rhode Island IN 18 Indiana SC 45 South Carolina IA 19 Iowa SD 46 South Dakota KS 20 Kansas TN 47 Tennessee KY 21 Kentucky TX 48 Texas LA 22 Louisiana UT 49 Utah ME 23 Maine VT 50 Vermont MD 24 Maryland VA 51 Virginia MA 25 Massachusetts WA 53 Washington MI 26 Michigan WV 54 West Virginia MN 27 Minnesota WI 55 Wisconsin MS 28 Mississippi WY 56 Wyoming MO 29 Missouri 97 Other*

Canadian Provinces and Territories AB 60 Alberta NU 67 Nunavut BC 61 British Columbia ON 68 Ontario MB 62 Manitoba PE 69 Prince Edward Island NB 63 New Brunswick QC 70 Quebec NL 64 New Foundland & Labrador SK 71 Saskatchewan NT 65 Northwest Territory YT 72 Yukon Territory NS 66 Nova Scotia

76

Appendix B Diagram of a Work Zone Area

Termination Area lets traffic resume normal operations

Activity Area is where work takes place

Transition Area moves traffic out of

its normal path

Advance Warning Area tells traffic what to

expect ahead

Work Space is set aside for

workers, equipment, and material storage

Buffer Space (longitudinal)

provides protection for traffic and workers

Traffic Space allows traffic

to pass through the activity area

Buffer Space (lateral) provides

protection for traffic and workers

Direction of Travel

77

Appendix C

CLOCKPOINT DIAGRAM

12

1

2

3

4

5

6

7

8

9

10

11

12

1

2

3

4

5

6

7

8

9

10

11

78

Appendix D

Diagram of the Trafficway*

*Source: ANSI D16.1-1996 Manual on Classification of Motor Vehicle Traffic

Accidents, Sixth Edition.

Road withoutShoulders

Sho

ulde

r

Sho

ulde

r

Prop

erty

Lin

e

Prop

erty

Lin

e

Trafficway

Road

Roa

dway

Roa

dsid

e

2-la

ne F

ront

age

Roa

d

Sepa

rato

r

Roa

dsid

e

Road withShoulders

2-LaneFrontage Road

Med

ian

Road withoutShoulders

Shou

lder

Shou

lder

Prop

erty

Lin

e

Prop

erty

Lin

e

Trafficway

Road

Roa

dway

Road

side

Roa

dway

Sep

arat

or

Roa

dsid

e

Road withShoulders

Med

ian

79

Appendix D (continued)

South Dakota’s Motor Vehicle Traffic Accident Reporting ...

Documents